AccountId: 011433970860
ContactId: 31422e0c-beaf-4f18-8fda-933ae7bc8835
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419380 ms
Total Talk Time (AGENT): 166174 ms
Total Talk Time (CUSTOMER): 98138 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/31422e0c-beaf-4f18-8fda-933ae7bc8835_20250109T20:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII], it's [PII] calling from provider's office to check on claim status. Could you help on contact you for me?
[AGENT][NEUTRAL] Yes, I can assist you with the claim status and [PII], how many claims do you have today in total?
[CUSTOMER][NEUTRAL] Uh only one claim.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The contact number is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The patient policy number is
[CUSTOMER][NEUTRAL] 01895358.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, go ahead, take your time.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The first name is spelled there, sir.
[CUSTOMER][NEUTRAL] [PII]. It's [PII] The last name is [PII]. It's [PII] The date of birth of [PII].
[AGENT][NEUTRAL] OK, you said the policy number is 1895358?
[CUSTOMER][NEUTRAL] 01895358.
[AGENT][NEUTRAL] OK, let me see if she's in.
[AGENT][NEUTRAL] Yeah, so that policy number is bringing up a different member. Do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, I, I didn't have a claim number.
[AGENT][NEUTRAL] OK, um, do you have the member's social?
[CUSTOMER][NEUTRAL] Just don't have the social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the member's name?
[CUSTOMER][NEUTRAL] The number's name, the first name is spelled as [PII].
[CUSTOMER][NEUTRAL] The last name is [PII].
[AGENT][NEUTRAL] OK, can you, um, and you've already verified the member's date of birth. Um, I thought you said a different name. My apologies. May I have the date of service for the claim that you're looking for?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's $7,943.25.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, hold on one moment, because this policy, OK, so this policy did not become active until [PII], but they did have another policy before then, which
[AGENT][NEUTRAL] Termed on Feb.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you repeat the date?
[AGENT][NEUTRAL] For the policy number that you gave, it did not become effective until [PII].
[AGENT][NEUTRAL] So the year after your data service?
[AGENT][NEUTRAL] There is a policy that was active previously, but that one didn't become effective until I'm sorry, that one termed on [PII]. I can check and see if there's a claim there, but that policy also was not active on your data service. Would you like me to check for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because, uh, no, because there is no any active coverage for the date of service.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Correct, but did you want me to see if there's a claim there that could be the denial reason?
[CUSTOMER][NEUTRAL] Yeah, could you please check it for me?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And I do see a claim here. Let me pull that for you. Hold on one moment.
[AGENT][NEUTRAL] So the claim or the policy number that this claim was processed on is 100.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 873 6.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] The claim number is 250.
[AGENT][NEUTRAL] 3310.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[CUSTOMER][POSITIVE] Yeah, thank you so much for the information. Mm.
[CUSTOMER][NEUTRAL] Can you to provide an EOB through fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 833.
[CUSTOMER][NEUTRAL] 826-684-3. No attention is [PII].
[AGENT][NEUTRAL] So that's [PII], attention, [PII]?
[CUSTOMER][NEUTRAL] Yup. All right. Yup.
[AGENT][NEUTRAL] All right, well, I'm sending this over to you now, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Nothing else. Thank you so much for the information. Can I have the call reference for the conversation?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] First initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you also, [PII] and thanks for calling APL. Bye-bye.