AccountId: 011433970860
ContactId: 49a68ec5-72c0-4591-b9a5-2e1385b55a01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409540 ms
Total Talk Time (AGENT): 136690 ms
Total Talk Time (CUSTOMER): 185551 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/49a68ec5-72c0-4591-b9a5-2e1385b55a01_20250319T18:24_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] Hey, [PII]. This is [PII] calling from Sequoia Memorial Hospital. How are you today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm good. Thanks for asking, [PII].
[AGENT][NEUTRAL] And how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] I'm looking for the claim status now.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] That's it man
[CUSTOMER][NEUTRAL] Yeah, it's [PII], no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mm, yeah. The member policy is
[CUSTOMER][NEUTRAL] 1359345.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Mm, yeah, it's [PII], [PII].
[CUSTOMER][NEUTRAL] When
[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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] And build the mountains.
[CUSTOMER][NEUTRAL] $1,537.70.
[CUSTOMER][NEUTRAL] What's that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so my NCCI check.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold while I, um, work on, look at the claim?
[CUSTOMER][NEUTRAL] Yeah, it is a hospital claim. Just want to tell you.
[AGENT][NEUTRAL] Thank you, I'm just locating it. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. Take your time. You are on hold.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] I can't do this all I wanna call.
[AGENT][NEUTRAL] $1,537 and here we go.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] That's what I did not. Was there any on that data service? 1223?
[AGENT][NEUTRAL] Wait, both of them are labs. OK. Oh no, it's not like the other one. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that claim number is 3559077.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You just
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] 3559077
[AGENT][NEUTRAL] Yes, and on [PII], the claim was denied because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] And this policy was active from [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And is there any other policy patient have?
[AGENT][NEUTRAL] There's no, no, there's no active policy with APL since then, since [PII].
[CUSTOMER][NEUTRAL] know.
[CUSTOMER][NEUTRAL] Mm, yeah. And do you have any, I mean, any other active policy information of the patient?
[AGENT][NEUTRAL] No, there's no active policy. If there is one, the member may have it with another company, but we do not have access to that.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] OK, uh, thank you. And can you, can we receive the you denied the U.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you. Hold on one moment. And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] And I'll go ahead and send the explanation of benefits over for you now. And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] me.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh, yeah, no, and how much time it would take to receive the EUV?
[AGENT][POSITIVE] I would say to give it at least an hour for the facts. If you haven't received it by the end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII], thank you very much. And could you please give me the call reference number?
[AGENT][NEUTRAL] Yeah, so there's no call reference number, but you can use my name in today's date, and again, that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Uh thank you very much. Have a good day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] I.