AccountId: 011433970860
ContactId: 427ced65-a384-4e61-92f6-c73d3dab01b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456029 ms
Total Talk Time (AGENT): 189017 ms
Total Talk Time (CUSTOMER): 109498 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/427ced65-a384-4e61-92f6-c73d3dab01b8_20250121T18:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is By calling from provider's office to check on a claim. Can you help me with that?
[AGENT][NEUTRAL] OK, you're needing to check on one coin status, is that correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have 2 claims for the same member.
[AGENT][NEUTRAL] Uh, yes, I can help you with that. And what is your name again? I'm sorry, I didn't understand you.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It is spelled as [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what's your callback number?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII]. That's direct line no extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Here, the member's policy number is 02557145.
[AGENT][POSITIVE] Thank you one moment [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I must have misheard the policy number because what I heard did not pull that number up. What is the policy number again?
[CUSTOMER][NEUTRAL] Yeah, the policy 97.
[AGENT][NEGATIVE] I'm sorry, [PII], I can't, [PII], your voice is too distorted. I can't understand what you're saying.
[CUSTOMER][NEUTRAL] Can you hear me better?
[AGENT][NEUTRAL] Uh, barely.
[CUSTOMER][NEUTRAL] Yeah, the member ID is 02557145.
[AGENT][NEUTRAL] OK, that is an incorrect policy number for that member.
[AGENT][NEUTRAL] Let me try, let me try once something that you said 0255. Is that correct?
[AGENT][NEUTRAL] What's the first part of the number? OK, just one moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, either any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth one more time, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is your first date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the billing amount is $3,459 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] First off, the effective date on this policy is [PII].
[AGENT][NEUTRAL] And it has a termination date of [PII]. There is no other active policy after the [PII] termination.
[AGENT][NEUTRAL] We did receive this claim, however, the was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number is 354-87557.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] And the reason for the denial state that our records indicate that premium for this service date was not received. Thereforere, benefits are not payable.
[CUSTOMER][NEUTRAL] I see. So the member was not active for the date of service, right?
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] I see and uh.
[CUSTOMER][NEUTRAL] Would, would you know if any other insurance was active for the member for the date of service?
[AGENT][NEUTRAL] Mm. No, ma'am. I would not, we do not have anything else, um, in our system, you would have to contact the member to find out about any other coverage they may have had.
[CUSTOMER][NEUTRAL] I see. And uh for the other claim also, could you give me the claim number and the receipt and the process date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is that data of service total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII], and the bill amount is $2,916.79.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so this claim was received on also 16, processed on 17.
[AGENT][NEUTRAL] And the claim number is 354-8748.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And denied for the same reason.
[CUSTOMER][POSITIVE] I see. Thank you so much. Uh, could you give me a call reference number for this?
[AGENT][POSITIVE] Yes ma'am, you would actually use my name that I gave you along with today's date.
[AGENT][NEUTRAL] And if you need a copy of either one of these explanation of benefits, uh, you may go to our portal at [PII], and you should be able to print those from there.
[AGENT][NEUTRAL] And is there anything else? Uh-huh, secured. [PII].
[CUSTOMER][POSITIVE] I see it's secured in public.
[CUSTOMER][POSITIVE] I see. Thank you so much for that. Uh, yeah, that will be all. Have a, have a great day ahead.
[AGENT][POSITIVE] Absolutely. You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I hope you do too, and thank you so much for calling APL.
[CUSTOMER][POSITIVE] Yeah, thank you so much bye bye.
[AGENT][POSITIVE] Oh, you're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.