AccountId: 011433970860
ContactId: 25bce44e-18e1-4abd-9a1b-fe88ac7d3fb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214270 ms
Total Talk Time (AGENT): 104400 ms
Total Talk Time (CUSTOMER): 61477 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/25bce44e-18e1-4abd-9a1b-fe88ac7d3fb5_20250130T22:22_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] Hi, my name is [PII] calling from provider's office to verify claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One claim
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. It is a direct line, no extension.
[AGENT][NEUTRAL] OK, and may I have the um member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02140831 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, 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] Yes, sir. So the date of service, it is.
[CUSTOMER][NEUTRAL] [PII] with the amount of $5,235 even.
[AGENT][NEUTRAL] Thank you. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The facility name is HCA Florida Kendal Hospital.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3547501.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated?
[AGENT][NEUTRAL] And this policy was active from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait a minute. 03. Wait a minute.
[AGENT][NEUTRAL] Hold on one second. This may need to go back for reprocessing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is from [PII].
[AGENT][NEUTRAL] Oh, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, this needs to go back to be reprocessed. The date of service is [PII]. The policy didn't turn until [PII], so it was active on the data service. So I can go ahead and send this back to be reprocessed and um you will receive another decision for this claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And could you please tell me the turnaround time?
[AGENT][NEUTRAL] Um, just to be on the safe side, I'll say 7 to 10 business days, that's the normal turnaround time. It could be less since it's already processed. I'm not sure.
[CUSTOMER][NEUTRAL] OK, thank you. And could you please help me with the call reference number?
[AGENT][NEUTRAL] Sure, uh my name or the call reference number, there is none. You can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for your time and assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You also, and thanks for calling APL, Lucy. Bye-bye.