AccountId: 011433970860
ContactId: 156ef5c5-9b9e-41a3-855c-81c5d901ff5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285489 ms
Total Talk Time (AGENT): 131070 ms
Total Talk Time (CUSTOMER): 60047 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/156ef5c5-9b9e-41a3-855c-81c5d901ff5f_20250523T17:35_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Prisma House of Claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] You said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Sure, let me go back to that. It is 02351431.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And I apologize, you said you wanted to check on claim status or eligibility?
[CUSTOMER][POSITIVE] Yes, clean.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $3,087.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that claim number is 357.
[AGENT][NEUTRAL] 8414
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEGATIVE] It looks like this was denied because our records indicate that the premium for this service date was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] If the premium is being paid through through COR, please contact us at [PII].
[AGENT][NEUTRAL] [PII] option 2.
[AGENT][NEUTRAL] But it looks like the um.
[AGENT][NEGATIVE] The premium hadn't been paid and so the claim got denied.
[CUSTOMER][NEUTRAL] Oh, OK. Is it possible the patient can go back and pay it and the claim can be paid or no?
[AGENT][NEUTRAL] Um, if they went back and paid it, they can always resubmit the claim.
[AGENT][NEUTRAL] We don't have timely filing limits, um, so they can submit the claim as long as the policy was active.
[AGENT][NEUTRAL] But I don't think that it backtracks.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00, OK, thank you. Yeah a call right. Oh, can I have the, is there any possible way you could send me that denial?
[AGENT][NEUTRAL] Give me one moment, uh, would you like it through fax?
[CUSTOMER][POSITIVE] That'd be great.
[AGENT][NEUTRAL] OK, and what's your fax number?
[CUSTOMER][NEUTRAL] [PII] 0 I'm sorry.
[AGENT][NEUTRAL] I'm sorry, what? Please start over. I'm sorry. The, it, it went out and so I didn't hear the first few numbers.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh sorry [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I have [PII], correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Alright, I will get that faxed over once I get off, um, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh, just a call reference number.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial, so [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Great, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.