AccountId: 011433970860
ContactId: 13ea286d-9199-40e3-8b15-566a9808d78a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266059 ms
Total Talk Time (AGENT): 72219 ms
Total Talk Time (CUSTOMER): 65283 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/13ea286d-9199-40e3-8b15-566a9808d78a_20250529T18:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and I'm calling from provider to check on the additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. How are you doing today?
[AGENT][NEUTRAL] I'm fine. And I'm sorry, your name is again?
[CUSTOMER][NEUTRAL] [PII], and [PII], OK with the last name is [PII]. May I have your name as well?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII]. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] D delta 448.
[CUSTOMER][NEUTRAL] 04051.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. You have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And spell that last name for me, please?
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said his date of birth is [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. And you say you're calling for a claim status, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge? I can verify that for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Bill amount of $550 even.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] That, that is.
[CUSTOMER][NEUTRAL] Previa Medical Group LL
[AGENT][NEUTRAL] OK, uh, I'm showing that claim process as premium was not received for the date of service, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] It means the member is not active for the date of service?
[AGENT][NEUTRAL] Uh, showing they're not eligible or not eligible for the data service.
[CUSTOMER][NEUTRAL] May I know the effective and termination date?
[AGENT][NEUTRAL] Effective date [PII] and I show the policy has been active.
[CUSTOMER][NEUTRAL] If the member pays the premium or the claim will be sent back for the process.
[AGENT][NEUTRAL] Once we receive eligibility information from benefits in the card and then they'll go back and reprocess the claim.
[CUSTOMER][NEUTRAL] Is there any time frame uh within?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and is there anything else, [PII], I can assist you with?
[CUSTOMER][NEUTRAL] May I know the call reference number?
[AGENT][NEUTRAL] Sure, you may use my name in today's date.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for the assistance. Have a great day. Bye-bye. Enjoy the rest of the day. Take care.
[AGENT][POSITIVE] Oh you too thank you for calling AP.