AccountId: 011433970860
ContactId: 1b159955-565f-46e6-93e2-908b48bfd365
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482279 ms
Total Talk Time (AGENT): 153647 ms
Total Talk Time (CUSTOMER): 57030 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/1b159955-565f-46e6-93e2-908b48bfd365_20250617T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. I'm calling from a doctor's office regarding a claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim that you're needing to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 02572501.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Just a moment. You said 02572501. Is that correct?
[CUSTOMER][NEUTRAL] Uh yeah, 02572501, yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII], would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII]. [PII] is the date of birth.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] The date of service is [PII] for $315 even.
[AGENT][NEUTRAL] 315. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received on 422-25 and it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number, [PII], is 359.
[AGENT][NEUTRAL] 3355.
[AGENT][NEUTRAL] The reason for the denial states the charges submitted are not payable because services were rendered prior to the policy's effective date.
[CUSTOMER][NEUTRAL] What is the policy effective date?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This policy's effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII], you can print it yourself now that you have the claim number by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] You can contact me the EOB.
[AGENT][NEUTRAL] Are you not able to print it yourself?
[CUSTOMER][NEUTRAL] So you said [PII], right?
[AGENT][NEUTRAL] [PII] is the website for our portal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we have to create the portal access like providers access right?
[AGENT][NEUTRAL] Yes, so you would register it's a self-registering portal.
[AGENT][NEUTRAL] And you should be able to access that EOB by using that claim number.
[AGENT][NEUTRAL] No, I will, I can fax you this one. I will, I will fax you this one so that you, that you, to give you time to set up your profile.
[CUSTOMER][POSITIVE] Yes please, yes.
[AGENT][NEUTRAL] OK, so just a moment for it to load.
[AGENT][NEUTRAL] I'm still, still waiting for it to load.
[AGENT][NEUTRAL] And will it need to be put to your attention date once it does pull up?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the first initials for your last name [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII],
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your fax number please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and to repeat that back, [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK. So that has just been sent uh to you via fax, so you should be receiving that very soon.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] OK, thank you so much right.
[CUSTOMER][NEUTRAL] Car reference number.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] OK. Well, you're welcome and thank you for calling APL. I hope you have a nice day also.