AccountId: 011433970860
ContactId: 181dd10c-420d-48d8-befa-69d5366adbe3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329119 ms
Total Talk Time (AGENT): 131671 ms
Total Talk Time (CUSTOMER): 68229 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/181dd10c-420d-48d8-befa-69d5366adbe3_20250128T14:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ABL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. Hi, [PII]. This is [PII] calling from a provider's office to check claim status.
[AGENT][NEUTRAL] OK [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And now then, what is your callback number?
[CUSTOMER][NEUTRAL] It is going to be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And now how many claims do you have to check?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, I can help you. And what is that member's policy number?
[CUSTOMER][NEUTRAL] So it's going to be 012.
[CUSTOMER][NEUTRAL] 662-0
[CUSTOMER][NEUTRAL] 6, M as in Mike.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is, uh, well, give me just one second.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, so the member's name is, uh, [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, this is for [PII] for bill amount of $144 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim has been received multiple times and most recently received claim was denied as a duplicate. Do you just need the original claims information?
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] OK, so the original claim, one moment.
[AGENT][NEUTRAL] The original claim was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 984 3.
[AGENT][NEUTRAL] And the excuse me, the reason for the denial on this claim, [PII], states that services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, may I know the patient's policy effective and termination date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This policy had an effective date of [PII].
[AGENT][NEUTRAL] And uh I'm sorry, I'm sorry, let's do that again. The effective date is [PII] term date [PII], and there was no policy active for this data service with our company.
[CUSTOMER][NEUTRAL] So it seems to be the patient's policy is not active for the data services and the patients have any other insurance uh for the date of.
[AGENT][NEGATIVE] Not with us that's what I just stated. That's what I just stated there was no other coverage active with our company for her data service.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] So, may I know the patient plan type?
[AGENT][NEUTRAL] Supplemental Medin, we are not a major medical insurance company.
[CUSTOMER][POSITIVE] OK. So thank you so much for all this information. And uh can I have a call reference number for this call?
[AGENT][POSITIVE] Yeah, so you're welcome.
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][NEUTRAL] Uh, may I know your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. So, thank you so much, uh, [PII], for all this information, and you have a great day.
[AGENT][POSITIVE] OK. You're very welcome and thank you again for calling APLL and I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.