AccountId: 011433970860
ContactId: 2721a4a9-b4a9-4f90-b8f2-59829f7bee70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343619 ms
Total Talk Time (AGENT): 161581 ms
Total Talk Time (CUSTOMER): 88903 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/2721a4a9-b4a9-4f90-b8f2-59829f7bee70_20250523T15:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, [PII]. My name is [PII]. I'm calling from provider's office and I have some questions regarding a claims. Uh, will you please help me with that?
[AGENT][NEUTRAL] OK, you have a question regarding one claim? Is it, is that correct?
[CUSTOMER][NEGATIVE] Uh yes, yeah, claim denial actually.
[AGENT][POSITIVE] Yes, I can help you.
[AGENT][POSITIVE] Yes, I can help you with that. And if you could spell your name for me, please?
[CUSTOMER][NEUTRAL] Oh yeah, it is [PII], with last name initial [PII].
[AGENT][NEUTRAL] OK. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII] direct line.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Oh yeah, the member ID number it is um 90 sorry, it is 02150149 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you one moment please while I get the member's information pulled up and I can help you regarding going over the reason for a denial, so one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service that is [PII]. The amount is $757 even.
[AGENT][NEUTRAL] Thank you. And what is the claim number? Do you have that?
[CUSTOMER][NEUTRAL] It is 3597853.
[AGENT][NEUTRAL] OK, so yes, sir, I do see that claim on file.
[AGENT][NEUTRAL] And the reason for the denial on this claim.
[AGENT][NEUTRAL] States that services
[AGENT][NEUTRAL] Excuse me. These services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy had an effective date of [PII] and it turned 7-1-2023.
[CUSTOMER][NEUTRAL] Oh, so basically the member's policy was not active with the service, right?
[AGENT][NEUTRAL] And there is no active coverage. That is correct. There was no policy active with our company for this data service.
[CUSTOMER][NEUTRAL] There is no active coverage for this member after that, right?
[AGENT][NEUTRAL] Not with APL.
[CUSTOMER][NEUTRAL] After the plan, uh, after the first plan terminated.
[AGENT][NEUTRAL] Not with APL, that is correct. We, she did not have an active policy with APL for this data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So can I know when exactly the claim was received in your end please.
[AGENT][NEUTRAL] This claim was received on [PII] and denied on [PII].
[CUSTOMER][NEGATIVE] Oh, OK. And the member does not have the courage.
[AGENT][NEUTRAL] And if you need a car.
[AGENT][NEUTRAL] No, sir, she hasn't had coverage since [PII] with AP. I'm sorry, this policy actually termed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me give you those dates again. I thought I may have given you the wrong date. This policy, the number you gave me, yeah, I did, was effective [PII], termed [PII].
[AGENT][NEUTRAL] And your service date is in the year [PII]. No active coverage with our company.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you need a copy of that explanation of benefit attached that has that email, I mean that remark on it, you can print it with that claim number if you go to [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, exactly. I can, I know that I need to pull that from that. Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Website, that is correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No problem. Go me the reference number for our conversation, please.
[AGENT][NEUTRAL] I'm sorry, did you ask for a reference number?
[CUSTOMER][POSITIVE] Exactly, the reference number, correct.
[AGENT][NEUTRAL] Yes, you would use my name that I gave you along with today's date, and the first initial to my last name is also [PII].
[CUSTOMER][NEUTRAL] What is the first initial?
[CUSTOMER][POSITIVE] OK, that is great, [PII]. You have a wonderful day then.
[AGENT][POSITIVE] OK, well then, if that is all I could help you with, [PII]. Thank you for calling APL. I hope you have a wonderful day as well and a nice um holiday weekend.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, well thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] No