AccountId: 011433970860
ContactId: f462e5a1-575b-47c4-b6c2-49563e8ebe88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541070 ms
Total Talk Time (AGENT): 122391 ms
Total Talk Time (CUSTOMER): 122647 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/f462e5a1-575b-47c4-b6c2-49563e8ebe88_20250509T17:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on your status for claims GP.
[AGENT][NEUTRAL] OK, I can help you on claim status, [PII]. May I please get your callback number, sir, just in case the call is disconnected.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes. [PII] and the [PII] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes. My name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] And member ID 02583369.
[AGENT][NEUTRAL] OK, let me look that up real quick, sir.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] OK, and then may I please have the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, data service [PII] bill on $36 even.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling for [PII]?
[CUSTOMER][NEUTRAL] Yes, Kettering Network Radiologist Incorporated.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, sir, while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] And, and for this one, we have submitted appeal with medical records on [PII] through mailing. Claim number ending 6852. Just take your time.
[AGENT][NEUTRAL] OK, what is the full claim number?
[CUSTOMER][NEUTRAL] Yes, full claim number 356-685-2.
[AGENT][POSITIVE] OK, thank you. That's very helpful. I'm gonna put you on a quick hold while I look this up for us and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Oh, looking on the claim, the claim has been denied because the benefit maximum for that date of service was met.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] And when the appeal receive date and upheal date.
[AGENT][NEUTRAL] Uh, let me look real quick.
[CUSTOMER][NEUTRAL] And uh may I know your name and spelling?
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] Let me look real quick sir.
[CUSTOMER][POSITIVE] Thank you and receive date and upload it.
[AGENT][NEUTRAL] OK, hold on real quick I'm trying to find that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. And when did you say you sent in the appeal?
[CUSTOMER][NEUTRAL] Yes, [PII] through mailing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a claim number 3566852.
[AGENT][NEUTRAL] Right, that's the claim number that I looked up, um, and that was.
[AGENT][NEUTRAL] Processed on [PII]. I do not see an appeal that came in.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Uh, could you please verify whether the
[CUSTOMER][NEUTRAL] No, could you be certified with the uh appeal or reconsideration or medical records received or not and uh we have received the correspondence on.
[AGENT][NEUTRAL] I do not
[CUSTOMER][NEUTRAL] Uh, [PII]. Could you please verify it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check one more time for me because they appear.
[AGENT][NEUTRAL] OK, on [PII], you received a correspondence.
[CUSTOMER][NEUTRAL] It's, yes.
[AGENT][NEUTRAL] And what did the correspondence say?
[CUSTOMER][NEUTRAL] Yes, uh, the letter received in our office on [PII], claim made under [PII] Group Limited Benefit Hospital indemnity insurance plan.
[AGENT][NEUTRAL] OK, at this time we do not have any appeal information.
[CUSTOMER][NEUTRAL] Uh, so we need to resubmit the appeal.
[AGENT][NEUTRAL] No, you received confirmation they got it. It looks like it's in process, but there's no information at this time.
[CUSTOMER][NEUTRAL] Uh, so we need more time for this one.
[AGENT][POSITIVE] Yes, allow more time.
[CUSTOMER][NEUTRAL] They received it [PII], so we need to one more time.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And do you have any case number?
[AGENT][NEUTRAL] No, sir. I do not have a case number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] And uh there is no case number, no document control number.
[AGENT][NEUTRAL] No, not at this time.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] And the card reference number?
[AGENT][NEUTRAL] You can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] And uh may I know the maximum amount and uh
[CUSTOMER][NEUTRAL] I mean the allowable maximum unit for this one?
[AGENT][NEUTRAL] The allowable maximum for this one is, let me see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding, and this is just to verify benefits. It's not a guarantee of payment. The allowable maximum is $50.
[AGENT][NEUTRAL] Hello.