AccountId: 011433970860
ContactId: 4691c98e-dcb1-4e18-9d5b-6b1ccc828583
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445779 ms
Total Talk Time (AGENT): 199783 ms
Total Talk Time (CUSTOMER): 95775 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/4691c98e-dcb1-4e18-9d5b-6b1ccc828583_20250505T19:15_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] Morning [PII], or good afternoon. This is [PII] calling from uh Lawrence Memorial Hospital. How's it going?
[AGENT][POSITIVE] Uh, it's great, [PII]. How about yourself today?
[CUSTOMER][NEGATIVE] It's gone horrible.
[AGENT][NEGATIVE] Oh, that's not good. It's only Monday. It's a long time to go for the rest of the work week if you work Monday through Friday like me and today's horrible. Oh, that's gonna be a long week.
[CUSTOMER][NEGATIVE] No, I'm just messing with you.
[CUSTOMER][NEUTRAL] Oh yeah, no, I, I was discussing with you today is fine other than the, uh, the weather.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] Uh, not good today, huh?
[CUSTOMER][NEGATIVE] Yeah, it's, uh, it's raining pretty hard.
[AGENT][NEUTRAL] Oh, wow. We're gonna have that where I'm located over the next several days. Here today, it's beautiful, but I think it's gonna kind of be the last day of that.
[AGENT][NEUTRAL] For a few days. Mhm. Right. Well, how can I help you today, [PII]?
[CUSTOMER][POSITIVE] Oh yeah, no, enjoy it, enjoy what was.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] I'm calling in regards to a uh a member's medical claim.
[AGENT][NEUTRAL] You needing claim status?
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Yeah, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] I have it listed as 2476697.
[AGENT][NEUTRAL] Thank you. All right, give me just a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is the patient's name, [PII], and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The Data service is going to be uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's what they uh bill amounts of $3,168.95.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] to find
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] OK, so this claim was received, the received date on here.
[AGENT][NEGATIVE] Was 115 of 24 and it was processed and denied on [PII].
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 7112.
[AGENT][NEUTRAL] And this claim was denied with the remarks stating.
[AGENT][NEUTRAL] Our records indicate.
[AGENT][NEUTRAL] That premium for this service date was not received, therefore benefits are not payable. This policy actually termed Andre on [PII].
[CUSTOMER][NEUTRAL] [PII] you said?
[AGENT][NEUTRAL] [PII], correct, it's the termination date of this policy.
[CUSTOMER][NEUTRAL] OK, so it was, uh, their, their coverage just turned on the data service, OK.
[AGENT][NEGATIVE] It's not active for the day.
[AGENT][NEUTRAL] It was termed prior to the day prior to your date of service.
[CUSTOMER][NEUTRAL] OK, got you. Do you think you can, uh, fax me over a copy of that EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I can also give you a website for future reference that you can also, once you, if you have the claim number, uh, you can print it from our portal and our portal website is located at [PII].
[AGENT][NEUTRAL] But give me just a moment to get this pulled up and I'll fax you this one.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just takes a moment to load up.
[AGENT][NEUTRAL] And does this need to go to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah, attention to Andre is fine.
[AGENT][NEUTRAL] A [PII] R E?
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and what is your fax number?
[CUSTOMER][NEUTRAL] The number is gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I'm just gonna repeat it back. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] You got it.
[AGENT][POSITIVE] Alright, well it is on its way to you provided that there's not any type of technical glitch, so you should be receiving that very soon, um, and again, and for future reference, you know, you may wanna try to also print it from the portal that may be easier um for you but it's on its way.
[CUSTOMER][POSITIVE] Alrighty sounds good. I can just get your name again and the reference for the call. I should be good to go.
[AGENT][NEUTRAL] All right, doctor.
[AGENT][NEUTRAL] Um, my name and today's date will be your call reference number, and again, my name is [PII].
[CUSTOMER][POSITIVE] Alrighty, great, uh thanks for your help. I appreciate it.
[AGENT][POSITIVE] OK, well, you're certainly very welcome and thank you again for calling APL. I hope you have a very nice afternoon and hopefully the rest of your week goes well as also safe.
[CUSTOMER][POSITIVE] Oh well thank you appreciate it.
[AGENT][POSITIVE] All right. You're welcome.
[AGENT][NEUTRAL] Mhm. All right. You too. Bye-bye.
[CUSTOMER][POSITIVE] Alrighty take care bye bye.