AccountId: 011433970860
ContactId: 3006c751-56bc-4fb7-bf7b-a21142a2b449
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271519 ms
Total Talk Time (AGENT): 108483 ms
Total Talk Time (CUSTOMER): 98997 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/3006c751-56bc-4fb7-bf7b-a21142a2b449_20250604T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello, thank you very much. Um, yes, I'm [PII]. I'm calling on behalf of Bonsa Course Hospitals. I would like to check on my claim status, please.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] Yes ma'am. I'm going to spell that for you. That is going to be [PII]. Uh, first letter of my last name will be [PII], and the callback number will be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, that will be 02046865.
[AGENT][NEUTRAL] OK, and please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh yes. Her name is [PII] and date of birth would be [PII].
[AGENT][NEUTRAL] OK, and the date of service and those charges on the claim, please.
[CUSTOMER][NEUTRAL] Date of service, [PII] and bill amount would be $390.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file for [PII]. Um, how was it submitted?
[CUSTOMER][NEUTRAL] Um, let me see here.
[CUSTOMER][NEUTRAL] We're seeing here that the uh
[AGENT][NEUTRAL] OK, and I'll
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, tell me.
[AGENT][NEUTRAL] Oh, just advising you the verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and it actually expired on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm sorry, you told me that uh when it started?
[AGENT][NEUTRAL] Um, it was effective on [PII], and it expired on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK, I understand. Well, I guess, uh, this would not cover this claim.
[AGENT][NEUTRAL] Yeah. But if you still need to submit the claim, if you still need an EOB or need to submit it, I can um assist you with that information. Would you like to verify how it was submitted?
[CUSTOMER][NEUTRAL] Oh, yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, how was it submitted?
[CUSTOMER][NEUTRAL] Well, we're seeing here that the uh
[CUSTOMER][NEUTRAL] Let me see, the address it was submitted it was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, yes, ma'am. That's the correct mailing address and claims can also be faxed in and we have a pair ID.
[CUSTOMER][NEUTRAL] Oh, OK. What is the ID?
[AGENT][NEUTRAL] Um, the payer ID is 60801.
[CUSTOMER][NEUTRAL] 6080.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. So you would think that the correct uh like process would be to resubmit the claim?
[AGENT][NEUTRAL] Um, well, it was still denied, but if you needed to resubmit the claim, if you needed an explanation of benefits, um, for that denial, then yes, you can still submit the claim through the payer ID or you can fax it.
[CUSTOMER][NEUTRAL] And what is the denial then?
[AGENT][NEUTRAL] Um, the denial, it would deny because the policy expired.
[AGENT][NEUTRAL] It wasn't the date of service after [PII]?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] OK, perfect. Yes, thank you uh very much for that information. Um, can you please remind me your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, my name is [PII]. It's spelled [PII] and my last initial is [PII]. If you need a reference number, it will be my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] What should I say? Uh no, ma'am. That will be all. Thank you very much for the information.
[AGENT][POSITIVE] OK, thank you, [PII] for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.