AccountId: 011433970860
ContactId: 1eac7101-ab07-4c97-8204-39cb800fe789
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297630 ms
Total Talk Time (AGENT): 117964 ms
Total Talk Time (CUSTOMER): 82614 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/1eac7101-ab07-4c97-8204-39cb800fe789_20250109T19:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII]. I'm calling in to check on our claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, just one.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 859978
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Oh yeah, $2150.64 64.
[AGENT][NEUTRAL] OK, hold on one moment. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Perry's Regional Medical Center.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] And that claim number is 340.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 649 8.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I said that backwards. On [PII], it was received on [PII], it was processed.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And on the [PII], it was denied um.
[AGENT][NEUTRAL] Because our records indicate that the premium for this data service was not received, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK, so basically uh member is not active on data service.
[AGENT][NEUTRAL] Um, let me see if the policy was active. Um, hold on one moment.
[AGENT][NEUTRAL] The policy was active on the data service, but we did not receive premium for the policy to pay out claims from the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, basically, uh, the member needs to pay the premium, right?
[AGENT][NEUTRAL] Well, at this point, the policy is no longer active, um, so I'm, I'm not really sure how that would go because the policy is not active, so, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As of right now, the claim is denied because the premium wasn't received.
[CUSTOMER][NEUTRAL] OK, OK. Uh, that, that will be all right. OK.
[CUSTOMER][NEUTRAL] Um, is there an EOB for this?
[AGENT][NEUTRAL] Yes, um, would you like me to fax you a copy?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, well, I'm gonna, I'm sending this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, no, that will be all. Um, how long is it gonna take for the fax?
[AGENT][NEUTRAL] Um, I'll say by end of day, um, but we usually say they give faxes at least an hour to be received.
[CUSTOMER][POSITIVE] OK, all right then thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day and happy New [PII].
[CUSTOMER][POSITIVE] You as well. Take care bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.