AccountId: 011433970860
ContactId: 31381311-ce51-483d-bbd9-f2599c984a1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245059 ms
Total Talk Time (AGENT): 96988 ms
Total Talk Time (CUSTOMER): 84093 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/31381311-ce51-483d-bbd9-f2599c984a1e_20250121T18:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for provider's office to check on denial claim clarification. And please be noted, this call has been recorded, monitored for the quality and training purposes.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. And yes, my name is [PII]. Um, my name is spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Can I have your name again?
[CUSTOMER][POSITIVE] Thank you so much for that. Yeah, and my last name [PII] is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 00 I'm sorry 02230064.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $1,215.48. 1215.48.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, ma'am.
[CUSTOMER][NEUTRAL] Also, we received an.
[AGENT][NEUTRAL] Yes, I'm showing that we received this claim on [PII].
[AGENT][NEUTRAL] The claim processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 5861.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim denied because just let me advise you that verification of coverage does not guarantee payment of claims. Um, this claim denied because the effective date on this policy was [PII], and this policy expired on [PII].
[CUSTOMER][NEUTRAL] Policy.
[CUSTOMER][NEGATIVE] was expired.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Can I have an uh effective date again?
[AGENT][NEUTRAL] Um, yes, one moment. Let me get back to that screen.
[CUSTOMER][POSITIVE] I'm sorry for that.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. Thanks for your patience. The effective date was [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 2024, right?
[AGENT][NEUTRAL] Um, the effective date was [PII], and the policy expired [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Can you please check if the member has any other uh policy who's active on the date of service?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. I already checked and there was no active policies.
[CUSTOMER][NEUTRAL] One moment, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Well, thank you so much for your patience and for your assistance and have a great day. Bye-bye. Bye for now.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, no, nothing else. Thank you. Bye-bye.
[AGENT][POSITIVE] Mhm. Thank you, sir, for calling APO. You have a great day as well. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye.