AccountId: 011433970860
ContactId: 142c29dd-3f39-4906-bef5-6a1a0cfc8295
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501609 ms
Total Talk Time (AGENT): 120418 ms
Total Talk Time (CUSTOMER): 150811 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/142c29dd-3f39-4906-bef5-6a1a0cfc8295_20250404T17:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for the provider to check on the additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Yes, this story.
[AGENT][NEUTRAL] Yes, this is [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And I can help you with claim status, [PII]. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Thank you. The best callback number will be [PII].
[CUSTOMER][NEUTRAL] [PII]. And it is a direct line?
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's complete name is [PII]. The date of birth is on [PII]. Policy number is 024.
[CUSTOMER][NEUTRAL] 77,200.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service on [PII].
[CUSTOMER][NEGATIVE] It was totally bill for about $340 even.
[AGENT][NEUTRAL] OK. And what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Facility name it is?
[CUSTOMER][NEUTRAL] Gray's Internal Medicine LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim and I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much for holding for me, [PII].
[AGENT][NEUTRAL] So, on this claim,
[CUSTOMER][NEUTRAL] Yes, this story.
[AGENT][NEUTRAL] The claim number is 357-5954.
[AGENT][NEUTRAL] Premium was not received on this claim um we're waiting for eligibility from benefits and a card but since, since the claim had been processed the.
[AGENT][NEUTRAL] effective [PII].
[CUSTOMER][NEUTRAL] I'm so sorry, to, uh, the call was not, um, uh, could you please provide me the premium effective and termination date?
[AGENT][NEUTRAL] The effective date is [PII] and it terminated on [PII].
[CUSTOMER][POSITIVE] Thank you so much. So, here this claim state of service on [PII].
[CUSTOMER][NEUTRAL] So actually, the policy was inactive and it is awaiting for a premium within a grace period time. So member's policy is inactive on the date of service. Is it correct?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] And I'm looking to see if there's an active policy. So let me look real quick and see about that, see if there's another policy you could resubmit on. Let me look.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you, yes, please.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir. We have an active policy for this insured. Let me give you that policy number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It's 259-6440.
[AGENT][NEUTRAL] The effective date.
[CUSTOMER][NEUTRAL] Please provide me the policy effective and.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Please go ahead.
[AGENT][NEUTRAL] It's [PII] and the policy is active. It's still current.
[CUSTOMER][NEUTRAL] Thank you. It acts as a primary payer, is it correct?
[AGENT][NEUTRAL] Uh, this is a, a limited hospital indemnity plan. It's not major medical.
[CUSTOMER][NEUTRAL] Thank you for this information. One moment, please. Here, so the member ID it's invalid or not appropriate for this activity of service and it so it's need a clean claim, not a correct claim. It is correct, is it correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, could you please provide me or verify for me the
[CUSTOMER][NEUTRAL] Electronic payer ID and mailing address to submit the claim claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The PR ID I'm showing it is 60801. Is it the correct information?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. And please confirm the mailing address. Is it [PII]. ZIP code is [PII]. Is the correct information?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Um, may I get the timely filing limit to submit a clean claim for this policy number, please?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] So no timely filing. Thank you for this information. May I get the call referencesatory about this clean conversation, please?
[AGENT][NEUTRAL] Yes, uh, you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for your assistance on the past claim clarifications and have a great day. Happy weekend as well.
[AGENT][POSITIVE] You have a happy weekend too. Thank you very much for calling APL [PII]. Is that all I can help you with before we go?
[CUSTOMER][POSITIVE] Um, that's the last claim today and thank you so much for your assistance.
[AGENT][POSITIVE] OK, well, you take care and thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye bye.