AccountId: 011433970860
ContactId: f8d31c7b-07ca-4e11-b704-b7907bdc532b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553200 ms
Total Talk Time (AGENT): 127105 ms
Total Talk Time (CUSTOMER): 195584 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/f8d31c7b-07ca-4e11-b704-b7907bdc532b_20250522T14:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm, uh, hi, [PII]. My name is [PII] calling for doctor office and to check on Apple status, could you help me find that one?
[AGENT][NEUTRAL] Did you say you're looking for a claim?
[CUSTOMER][NEUTRAL] Uh, I guess, uh, we already submitted a bill. Just I'm looking for, uh, what, what's happening on the supply. It was, uh, it was in process or not.
[AGENT][NEUTRAL] Oh, OK. Um, [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, sure. It's [PII], and it's a direct line?
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member policy number is 02512593. And the member's name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] Just a moment. OK it's uh number 5, [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, what was the patient's name?
[CUSTOMER][NEUTRAL] Yeah, sure. Remember [PII].
[AGENT][NEUTRAL] OK, hold on. I'm not seeing.
[CUSTOMER][NEUTRAL] Uh, uh, just a moment.
[AGENT][NEUTRAL] That name. Give me 1 2nd.
[AGENT][NEUTRAL] I have policy number 02512590.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] 93.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] I'm sorry, what was after the 5?
[CUSTOMER][NEUTRAL] Uh, yes, it's 02512593.
[AGENT][NEUTRAL] OK. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you, you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And date of birth one more time, please.
[CUSTOMER][NEUTRAL] Yeah, sure. And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have a date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. The data service is [PII] and the total bill amount is $735 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see here, just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said the total billed amount was $735?
[CUSTOMER][NEUTRAL] It's 700, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the name of the provider?
[CUSTOMER][NEUTRAL] Yeah, yeah, uh, it's, uh, shall I go the uh the facility name is High Risk Optical Consultants.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the rendering product name is Aria Powder.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we paid partially to that claim.
[AGENT][NEUTRAL] Uh, it looks like we paid $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I'm sorry, $50 right?
[AGENT][NEUTRAL] Yes, because with that.
[CUSTOMER][NEUTRAL] 50. Am I right?
[AGENT][NEUTRAL] Yes, sir. So with that payment, the check, with that check, the maximum benefit payable for that date of service has been met.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yes, and that's the reason we submit an app with the complete medical records through fax on [PII]. And may I know the status?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you talking about a different claim?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Are you talking about a different claim?
[CUSTOMER][NEUTRAL] Uh, uh, no, I'm talking on the same claim. Uh, for this claim, we submit an appeal on this claim.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What, what about the status?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] I'm showing the others were denied because um the calendar year had been met.
[CUSTOMER][NEUTRAL] Uh, may I know the date?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like we received that claim on [PII], and it was processed and payment was began on [PII].
[CUSTOMER][NEUTRAL] Uh, ma'am, ma'am, uh, uh, I'm not asking about the gender claim. I'm just asking about the status. Uh, we submitted an appeal on [PII] and previously make call on [PII] and this stated appeal was still in process. And now I'm calling about the what about the status for the apple. You, you, you, you provide me the gender claim status. We are, we already have the, the gender claim status, the claim of dinners.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, the maximum benefit, uh, it's already met. This is a recent time, right? And it was midd on [PII]. And we submit an appeal on this claim, uh, through fax. I'm just looking for the apple status about the status for the apple. It was, uh, uh, the appeal was still process or the apple is appealed or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what was the date?
[AGENT][NEUTRAL] Of the service?
[CUSTOMER][NEUTRAL] Uh yeah, we submit an appeal on [PII].
[AGENT][NEGATIVE] I'm not seeing anything for that.
[CUSTOMER][NEUTRAL] You not receive any other and uh is the fax number. Could you please check with the fax number? It's [PII]. This is the fax number, right? For some of the number.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So you're not see any uploads uh data service, right?
[AGENT][NEUTRAL] Right, not for [PII] [PII]. I'm not seeing anything.
[CUSTOMER][NEUTRAL] OK. OK. And may I know the timely filing limit?
[AGENT][NEUTRAL] Uh, we don't have timely filing, so as long as the policy was active, it can be filed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And no, uh no type TFL for Apple, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you so much. And yes, can I have the call reference number?
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date. So [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] a pleasure have a great day. Bye-bye [PII]ow.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK.