AccountId: 011433970860
ContactId: 3701a344-5e11-4e1e-a513-d3e81c92f279
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400160 ms
Total Talk Time (AGENT): 78621 ms
Total Talk Time (CUSTOMER): 136146 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/3701a344-5e11-4e1e-a513-d3e81c92f279_20250210T18:52_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. Very good afternoon. This is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Yes, I'm doing good. Thank you so much for asking, [PII]. I just have a patient for which I was calling in to check about the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status.
[AGENT][NEUTRAL] I'm sorry, repeat your first name for me?
[CUSTOMER][NEUTRAL] It's [PII]. It's spelled as [PII] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And [PII], if I can um get the policy number?
[CUSTOMER][NEUTRAL] Yes, definitely, [PII]. The policy number is 025451777.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. Now I do show the policy lapsed [PII].
[CUSTOMER][NEUTRAL] [PII]. So that means the patient's policy was not active?
[AGENT][NEUTRAL] Not since November [PII].
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII]. OK. Can you give me the effective date?
[AGENT][NEUTRAL] Effective [PII].
[CUSTOMER][NEUTRAL] OK, thank you and uh I just wanted to check the status for the claim so then it would have been possibly denied. Can you please check and help me find out?
[AGENT][NEUTRAL] Of course, and what's your tax ID?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that information. I'm showing the claim denied because there was no coverage at the time of service.
[CUSTOMER][POSITIVE] Wonderful. Claim was received and processed on what date?
[AGENT][NEUTRAL] Claim received on [PII], claim denied, I'm sorry, claim received on [PII], claim denied on [PII].
[CUSTOMER][NEUTRAL] I'm sorry, claim received on what date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Claim denied on [PII].
[CUSTOMER][NEUTRAL] And processed and denied on [PII]. OK.
[CUSTOMER][NEUTRAL] Give me one quick moment, almost done it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Almost done it, sorry to keep you waiting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, claim was denied because patient's policy was inactive.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] On the date, can you check if patient has any other policy like with another member ID possibly if it could be possible.
[AGENT][NEUTRAL] Um, no, they don't.
[CUSTOMER][NEUTRAL] They don't, right? So after that there was no policy.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Give me one quick moment. I would need to call uh the claim number before I let you go. Give me one quick moment. I'm checking into the system so that I can give you an appropriate answer.
[CUSTOMER][POSITIVE] Uh, almost done it. Apologize to keep you waiting.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Sorry for that.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Yes, yes, I'm fine.
[CUSTOMER][NEUTRAL] 11:20.
[CUSTOMER][NEUTRAL] Yes, it says American Life Insurance. So this is the American, right?
[CUSTOMER][NEUTRAL] American Life Insurance.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, no worries. With this I'm done with my question. Please help me with the claim number and the call reference number, [PII].
[AGENT][NEUTRAL] OK, reference is just my name [PII] last [PII] [PII], and the date and time of the call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 353-9212.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.