AccountId: 011433970860
ContactId: f0357361-dadb-4a61-bb4d-c96b2fe424f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 659940 ms
Total Talk Time (AGENT): 120581 ms
Total Talk Time (CUSTOMER): 107812 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/f0357361-dadb-4a61-bb4d-c96b2fe424f8_20250306T14:26_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh hello, [PII]. This is [PII] calling from West Boca Medical Center, and I need your help related to a claim.
[AGENT][POSITIVE] Sure, I can assist you with claims, Miss [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And may I have um the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number of the patient is
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 01635430.
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The data service is.
[CUSTOMER][NEUTRAL] [PII], total charges that were billed are $60,837.16.
[AGENT][NEUTRAL] OK, thank you. Alright, let me see if I can find this claim, and that was for [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment, and for future you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] And let's see. OK, let me pull this ELB.
[AGENT][NEUTRAL] I'm still waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] I do have the claim number. If you want, I can provide you the claim number.
[AGENT][NEUTRAL] No, it's fine. It looks like it was reprocess, Miss [PII].
[AGENT][NEUTRAL] OK, so it looks like um we have processed this the last time on [PII] and we send a benefit amount of $1,816.69.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and it looks like with the payment of that check, the maximum has been exhausted.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know was this claim processed as primary or secondary?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, by any chance, is it possible that we can submit an appeal because we expect a total of $3,678.44.
[AGENT][NEUTRAL] Um, you can always submit an appeal, but with the check, the maximum benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Yeah, I get that, but still as a courtesy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, 180 days from the decision date to submit any appeals.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I have the appeal mailing address first?
[AGENT][NEUTRAL] Sure, that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said the timely filing for this one is 180 days from the process date?
[AGENT][NEUTRAL] Correct. It's gonna be 180 days from the decision then.
[CUSTOMER][POSITIVE] OK. Well, thank you so much for this one. And uh may I have the reference number for interaction?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. And you say you don't need any other information on this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, that'll be all.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that would be all, thank you.
[AGENT][POSITIVE] OK, you're welcome, Miss [PII] and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You as well.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.