AccountId: 011433970860
ContactId: 29f9f55a-b4ae-4bf3-a1e5-70867683991d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258140 ms
Total Talk Time (AGENT): 113466 ms
Total Talk Time (CUSTOMER): 77100 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/29f9f55a-b4ae-4bf3-a1e5-70867683991d_20250520T21:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from the provider's office to check on a claim status. How are you today?
[AGENT][NEUTRAL] OK [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yes, sure. The callback number is going to be [PII]. It's a direct line extension.
[AGENT][NEUTRAL] Thank you, [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] Yes, sure. The policy number is going to be, which is 02543607.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I have that as 025436007. Thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, the name of the patient is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. I have that member pulled up again. You call for claim status so I can assist you. What is the date of service and the total charge amount, please?
[CUSTOMER][NEUTRAL] Sure, the date of service on the claim is going to be, which is [PII] with the total charges of $1,132 even.
[AGENT][POSITIVE] OK, that was $1,132 even. OK, thank you so much. Give me one moment please.
[CUSTOMER][POSITIVE] Sure, [PII]. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also you're able to check claim status by visiting our secure portal at [PII] and on that website you'll be able to obtain an EOB if you need that for your records. Um, give me one second please. I'm almost done this search.
[CUSTOMER][POSITIVE] Oh sure, sure, no problem. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] Can't believe I do show that we have received it.
[AGENT][NEGATIVE] And it shows that it it denied. Give me one second please, [PII].
[CUSTOMER][POSITIVE] Oh, sure, sure. Take your time.
[AGENT][POSITIVE] OK, thank you so.
[AGENT][NEUTRAL] Thank you. The claim shows received on [PII], and it was processed. It shows on [PII]. Uh, the claim denied. It shows that the policy has termed and it turned prior to the date of service.
[CUSTOMER][NEUTRAL] OK, so the claim was originally denied as the patient is inactive for the date of sales, right?
[AGENT][NEUTRAL] I'm sorry, give me one moment. Give me one second please, just to re-verify.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me, let me just recant what I just said, OK, let me just repeat the whole thing over. The claim was received on [PII] and processed and denied on [PII], but it denied because the services were rendered.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] After the policy term.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the patient is inactive for the date of service as the policy was termed, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any active policy after this uh data of service?
[AGENT][NEUTRAL] Let me check that for you one moment.
[CUSTOMER][POSITIVE] Sure, yeah, thank you.
[AGENT][NEUTRAL] No, the member does not have an active policy with APL.
[CUSTOMER][POSITIVE] Mhm thank you. So I think I got all the information needed on this link and I'm ready for the call reference number. Thank you.
[AGENT][NEUTRAL] You're welcome, [PII]. We do not provide call reference numbers, but you can use my name [PII] last initials [PII] and today's date.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh, thank you so much for providing me and resolving the issue on the claim engine. And thank you so much for your assistance. I wish you have a great day. Have a great week ahead. Thank you. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APL Alex. Take care. Bye bye.