AccountId: 011433970860
ContactId: 26a56d42-e471-4d10-a6ba-4c811f2db314
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 786619 ms
Total Talk Time (AGENT): 121281 ms
Total Talk Time (CUSTOMER): 128265 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/26a56d42-e471-4d10-a6ba-4c811f2db314_20250310T17:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. Could you please help me to claim status?
[AGENT][NEUTRAL] Sure. And what is your name?
[CUSTOMER][NEUTRAL] Uh, my name is spelled [PII]
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, yes, it's [PII] direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have um the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 02445904.
[CUSTOMER][NEUTRAL] And could you please spell your name for me? I didn't get your name.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, that's all. That's S [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] for $175 even.
[AGENT][NEUTRAL] OK, thank you. And that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and for future you can check claim status online through our website at [PII] and that's just optional and bear with me, let me pull this ELB.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, looks like we received the claim on [PII] process [PII], and the claim was denied. The reason for this denial is that the service was rendered, um, let me see, the premium for the date of service was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Is there any other insurance for this patient for the date of service?
[AGENT][NEUTRAL] No, I'm with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy terminated [PII].
[CUSTOMER][NEUTRAL] [PII] just to confirm, you said you have received this claim on [PII] and processed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, give me one moment. Uh, could you please repeat the denier reason?
[AGENT][NEGATIVE] Our records indicate that the premium for the date of service was not received, therefore benefits are not payable. The policy is now terminated.
[AGENT][NEUTRAL] The termination date is [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Can I get the effective date?
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][POSITIVE] Yeah definitely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 3457478.
[CUSTOMER][POSITIVE] Thank you. Um, could you please, uh,
[CUSTOMER][NEUTRAL] Access this scenario we.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Attention to my name, [PII], it spells [PII]
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, can I get the time to receive the AOB?
[AGENT][NEUTRAL] I'm sorry, can you get one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Turn around time to receive the EOB.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] In a few minutes.
[CUSTOMER][NEUTRAL] 5 to 10 minutes.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] And can I get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you so much and you have a wonderful day.
[AGENT][POSITIVE] You're welcome. You as well. And thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] the