AccountId: 011433970860
ContactId: 0ba60d17-c83e-4556-8ce2-12de92a228d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299809 ms
Total Talk Time (AGENT): 85020 ms
Total Talk Time (CUSTOMER): 88674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/0ba60d17-c83e-4556-8ce2-12de92a228d9_20250204T22:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] and I'm calling in for North Carolina Emergency physicians. I verified the EOP and this is a call made for additional information about the denial. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] Fine I'm happy to check on a claim for you today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I have the member ID number here as D as in Delta 42510591.
[AGENT][MIXED] Thank you so much. Unfortunately I can't pull the number with that. Do you have a claim number or their name or social?
[CUSTOMER][NEUTRAL] Let me provide you the claim number. I have it as uh.
[CUSTOMER][NEUTRAL] 355-4750.
[AGENT][NEUTRAL] All right, let me pull that here. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] I have the member's name as [PII], and the date of birth is on [PII].
[AGENT][POSITIVE] All right, thank you so much. One moment.
[AGENT][NEUTRAL] So it looks like the claim was received on [PII]. Uh, the claim was denied. Patient plan is currently not active. We're waiting on premium.
[CUSTOMER][NEUTRAL] Hm, one moment.
[CUSTOMER][NEUTRAL] So does it mean like the patient was not active on the date of service?
[AGENT][NEUTRAL] That is correct. The member's plan termed on [PII].
[CUSTOMER][NEUTRAL] Mm one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. And when was the member active one?
[AGENT][NEUTRAL] Effective date was [PII].
[AGENT][NEUTRAL] 2nd, [PII].
[CUSTOMER][NEUTRAL] [PII]. Give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm checking.
[CUSTOMER][NEUTRAL] Got it. So, while, uh, the member was not active on the date of service, may I know that the policy got renewed after the termination?
[AGENT][NEUTRAL] There's no other active policy at this time.
[CUSTOMER][NEUTRAL] No, what I'm asking is, OK, so that it doesn't got renewed after the termination, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, did the member have any other active insurance during the date of service?
[AGENT][NEUTRAL] We do not have that information. You'd have to check with the insured.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Can I have the mailing address for my documentation purposes?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] What would be the timely filing limit?
[AGENT][NEUTRAL] For an appeal, uh, those have to be filed 180 days from the decision date.
[CUSTOMER][NEUTRAL] Mm one moment.
[CUSTOMER][NEUTRAL] Can I have a reference number for our call?
[AGENT][NEUTRAL] Call references my name with my last initial, then today's date. My name again is [PII], that's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Thank you so much for your kind assistance, sir. You have a wonderful day ahead.
[AGENT][NEUTRAL] You too [PII] bye bye.