AccountId: 011433970860
ContactId: 3dc55e61-8712-46c4-a532-0d1944542629
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524520 ms
Total Talk Time (AGENT): 190390 ms
Total Talk Time (CUSTOMER): 110318 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/3dc55e61-8712-46c4-a532-0d1944542629_20250416T18:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office to check the status of the claim.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The good contact number is [PII].
[CUSTOMER][NEUTRAL] And uh it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[CUSTOMER][NEUTRAL] Is the policy ID was 021.
[CUSTOMER][NEUTRAL] 41823, M as in Mike, L Lima, number 7.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] His member's name was uh
[CUSTOMER][NEUTRAL] Any [PII]?
[CUSTOMER][NEUTRAL] Sorry, any later? [PII], date of birth, uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, the rate of service was um uh [PII] with the bill amount of $10,000 even.
[AGENT][NEUTRAL] Thank you, hold on 11 moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It is uh Kendall Anesthesia Associates.
[AGENT][NEUTRAL] OK, so the claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is 3561732.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the charges, um, the charges aren't payable because the services were rendered prior to the policy's effective date. So this policy did not become effective until, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold so I can look at this claim or these claims?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] No, wait a minute.
[AGENT][NEUTRAL] 823. OK.
[AGENT][NEUTRAL] 823, 823 22. What?
[AGENT][NEUTRAL] OK, wait. Oh, hold on, hold on, hold on, I got it.
[AGENT][NEUTRAL] This policy wasn't active. Got it.
[AGENT][NEUTRAL] I think about that. I think that thing through. OK, yes, I figured it out.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] Thank you so much for holding. So the policy for Yilda did not become effective until [PII]. So for the data service, [PII], the policy was not active for that member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please check and uh let me know whether any policy active for the data for the data service.
[CUSTOMER][NEUTRAL] So, when the claim was denied?
[AGENT][NEUTRAL] Hold on one second, let me answer your first question. Let me take a look. Hold on one moment.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] There's only one more. Hold on one second, let me get that policy number and see if they're on there.
[AGENT][NEUTRAL] Wait, that doesn't make sense. So there is another policy, but the policy termed in [PII]. So the only policy that
[AGENT][NEUTRAL] Would count is the policy that we're working with, but the insured was not on the policy until [PII].
[CUSTOMER][NEUTRAL] Got it. Uh, so, uh, when the claim was denied?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The claim was denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] May I know the denial reason?
[AGENT][NEUTRAL] Yes, sir, we've just went over it. So the policy was not active for the member on this date of service. The date of service is [PII]. The policy did not become effective for Yilda until [PII].
[CUSTOMER][NEUTRAL] Got it. Uh, so, in this case, we can go ahead and uh.
[CUSTOMER][NEUTRAL] So, build the pay, the patient, right?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility, um, because we're the secondary insurance, we're not major medical, so that would be between primary and the provider to determine responsibility.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Got it. Uh, can I have the call reference number for today's our call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial of my last name is [PII], my first name is [PII]
[CUSTOMER][NEUTRAL] Sorry, uh, [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Thank you. Thanks for the information and helping on this invoice. Uh, and before going to hang up a call, uh, could you please send that, uh, the ID over through fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Sorry, sorry, from the beginning, it is [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Alright, and that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right, so I'll go ahead and fax that over to you now. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that's it from my end. Uh, nice talking. Thanks for the information helping on in my, uh, you know. Nice talking to you. Have a great day ahead.
[AGENT][POSITIVE] You're very welcome, [PII].
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.