AccountId: 011433970860
ContactId: 2333ff13-9f25-40f7-b1cb-1b9f485a19ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394140 ms
Total Talk Time (AGENT): 139241 ms
Total Talk Time (CUSTOMER): 117469 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/2333ff13-9f25-40f7-b1cb-1b9f485a19ec_20250307T13:56_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. I am [PII]. I'm calling from [PII]'s office. I'm on claim.
[AGENT][NEUTRAL] I'm sorry, I can barely hear you.
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEGATIVE] You sound very far away from your microphone.
[CUSTOMER][NEUTRAL] OK. Is it OK now?
[AGENT][NEUTRAL] No, sir, not really. You just, it sounds very far away. There is an echo.
[CUSTOMER][NEUTRAL] Uh, one moment, I'll just adjust.
[CUSTOMER][NEUTRAL] Uh hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Uh, now, can you hear me properly?
[AGENT][POSITIVE] That is better.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] Uh my name is [PII]. It's spells [PII]
[AGENT][NEUTRAL] [PII] Is that correct?
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK, [PII], and your callback number?
[CUSTOMER][NEUTRAL] Uh, callback number is, uh, just a moment, I'm getting that information.
[CUSTOMER][NEUTRAL] Forgot.
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][POSITIVE] Thank you. And how can I help you today?
[CUSTOMER][NEUTRAL] Yeah, actually, I have one claim. I'm just checking on the status.
[AGENT][NEUTRAL] OK, you're needing status for one claim, is that correct?
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] Yes, I can help you with that. And what, what is the member's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, policy number is 01835856.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. The date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] That'll build out please.
[CUSTOMER][POSITIVE] Yeah, the top services.
[CUSTOMER][NEUTRAL] [PII] for $81 even.
[AGENT][NEUTRAL] OK, thank you. So one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this policy number that you provided for me, Shade, is a, an old policy number that has not been in effect since [PII]. Let me see if the member has another policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] No, they do not. So let me see if we received and processed the claim under this policy number for her. Just one moment.
[CUSTOMER][NEUTRAL] OK, sure. May I know when it was done?
[AGENT][NEUTRAL] Again it was termed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 11. OK, thank you.
[CUSTOMER][NEUTRAL] Yeah, the patient, uh, like had like a second pair, so like do you know is there any like uh
[AGENT][NEUTRAL] We are the secondary. So give me just a moment to see if we even receive this claim. So just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEUTRAL] OK, so this claim was received, the received date on the claim was [PII].
[AGENT][NEUTRAL] And it was processed and denied on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] 2111.
[CUSTOMER][NEUTRAL] 111.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied as the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK, go.
[CUSTOMER][NEUTRAL] And no other policy, right?
[AGENT][NEUTRAL] And it
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And if you need a an EOB has been mailed, but we also have a portal that you should be able to print it from if you need that by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, sure. Thanks so much for that. And that's it for I made the call reference number?
[AGENT][NEUTRAL] Yes, sir, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] Well, you're very welcome. So is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Uh, that's it. Thank you.
[AGENT][POSITIVE] OK, well then thank you [PII] for calling APO and I hope you have a great day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] You too. Take care. Bye.
[AGENT][POSITIVE] Thank you. Oh, you too. Bye-bye.