AccountId: 011433970860
ContactId: 43ac7228-8117-481a-8ec0-807719dceeb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229350 ms
Total Talk Time (AGENT): 114985 ms
Total Talk Time (CUSTOMER): 45338 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/43ac7228-8117-481a-8ec0-807719dceeb0_20250306T18:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I need to get the status of a claim.
[AGENT][NEUTRAL] OK, you're needing to check claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] This is [PII] and what's your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Did you say the area code was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh, I'm sorry. OK, thank you.
[AGENT][NEUTRAL] And [PII], what is the um member's policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is 1291269.
[AGENT][NEUTRAL] OK OK thank you one moment please.
[AGENT][NEUTRAL] OK, and any information that I do provide for you, [PII], would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] 11 7 of 24 to 119 of 24 for $19,393.55.
[AGENT][NEUTRAL] OK, so give me just a couple of moments, please.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The received date on it was [PII] and it processed on [PII].
[AGENT][NEUTRAL] The claim number is going to be 356-52.
[CUSTOMER][NEUTRAL] I'm sorry, say, say that one more time.
[AGENT][NEUTRAL] Uh, the claim number? OK, it is 356-523-5.
[CUSTOMER][NEUTRAL] The claim number, yeah.
[AGENT][NEUTRAL] And this claim was denied, [PII]?
[AGENT][POSITIVE] I'm so sorry about that. I'm so sorry.
[AGENT][NEUTRAL] The reason for the denial states these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] What date did they turn?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. This policy term was active from [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, can I get a reference number?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date and if you need a copy of this explanation of benefits, [PII], you can go to our portal and you should be able to print that and our portal website is [PII].
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You are certainly welcome. Can I help you with anything else?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, well thank you again for calling APO and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Mhm bye.
[AGENT][NEUTRAL] Bye bye.