AccountId: 011433970860
ContactId: 12ee5aca-75c6-4bfe-a8f7-61efed5c291d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415179 ms
Total Talk Time (AGENT): 125755 ms
Total Talk Time (CUSTOMER): 182086 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/12ee5aca-75c6-4bfe-a8f7-61efed5c291d_20250520T13:57_UTC.wav
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[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for calling EPL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, good morning. This is [PII] calling from provider office. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] I'm doing good, thanks for asking. By the way, could you please repeat your name once again?
[AGENT][NEUTRAL] I'm sorry, you need my name again?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Not too heavy.
[AGENT][NEUTRAL] Yes, sir. Um, how can I assist you?
[CUSTOMER][NEUTRAL] So yeah, we are calling regarding, uh, yeah, so we are calling regarding the medical claim.
[AGENT][NEUTRAL] OK, yes, I can assist you with claim status. Um, first, could I get a little callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I'll provide you that. The callback number is [PII].
[CUSTOMER][NEUTRAL] The [PII] and the extension will be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, sure, the member ID will be.
[CUSTOMER][NEUTRAL] 8, sorry, 01885449 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient first name is [PII] and the date of birth will be on
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] It's on [PII]. The amount is $510.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, and please repeat the date of service.
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] OK. Yes, sir. I'm not showing that claim in our system, but the member does have a new policy number that the claim needs to be filed up under.
[CUSTOMER][NEUTRAL] Can you please check with another date of service?
[AGENT][NEUTRAL] Yes, um, do you need the policy number also? The new policy number?
[CUSTOMER][NEUTRAL] OK. The patient's policy has been changed.
[AGENT][NEUTRAL] Yes, the patient's policy number has been changed as of [PII].
[CUSTOMER][NEUTRAL] Yeah, go on, please.
[AGENT][NEUTRAL] Um, the new and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on the policy was [PII]. The policy is still active and the new policy number is 02486619.
[CUSTOMER][NEUTRAL] 02486619, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Got you. And you're saying that the [PII] claim was not on file? That was stated?
[AGENT][NEUTRAL] Yes, that claim is not on file.
[CUSTOMER][NEUTRAL] And there is a new policy which was started on [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], it was started on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. So, the member ID which I was provided with, is it uh before the [PII]?
[AGENT][NEUTRAL] Yes, um, the coverage date for that member ID was, um, the member ID was 1885449. The effective date on that policy was [PII] and that policy expired on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It was expired on [PII].
[CUSTOMER][NEUTRAL] [PII] [PII], right? 2024, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So the policy number which you have been provided now, which is 02486619 was uh started on [PII] and there is a no ended on this policy, right?
[AGENT][POSITIVE] Right. There's no end date. That's correct.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So I think that's the reason there's a no claim on file for the state of service, maybe?
[AGENT][NEUTRAL] Right. That's why the claim needs to be refiled under the new policy number.
[CUSTOMER][NEUTRAL] OK, so yeah, I got your point, Ay, but I just want, I just had a question from my side. I do see that there is a uh alphabets um member ID, but the member ID which you have been provided was there is no any alphabets on that.
[AGENT][NEUTRAL] OK, so what's your
[CUSTOMER][NEUTRAL] Is it a complete member ID which you have been provided me?
[AGENT][NEUTRAL] Yes, that's a complete member ID.
[CUSTOMER][NEUTRAL] It's 02486619, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] But I, I do see that the, for the pre uh previous date of service, uh sorry, previous member ID there's uh uh alphabets on member ID which is ML and 8.
[CUSTOMER][NEUTRAL] ML, sorry.
[AGENT][NEUTRAL] Right. We don't use that portion.
[CUSTOMER][NEUTRAL] Is there anything else like that?
[AGENT][NEUTRAL] We don't use that portion.
[CUSTOMER][NEUTRAL] OK. You don't use that three digit portion which was sent, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Got you. Yeah, no problem. And can you please have the card first before ending it?
[AGENT][NEUTRAL] Yes, the call reference number is my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, but nothing else. It's ABI and today's date, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] That's your point. Yeah, thanks for providing the information and assisting us today, [PII]. You have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL um bye.
[CUSTOMER][NEUTRAL] Yeah bye.