AccountId: 011433970860
ContactId: 4b204943-c19d-4a6f-9594-ba12e53d2fb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482019 ms
Total Talk Time (AGENT): 111071 ms
Total Talk Time (CUSTOMER): 110220 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/4b204943-c19d-4a6f-9594-ba12e53d2fb9_20250307T18:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] to my last name, [PII].
[AGENT][NEUTRAL] Hi, [PII].
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, uh, need to know the status of the claim, and I'm calling from provider office.
[AGENT][NEUTRAL] OK thank you [PII] I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah. [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] And the name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. And then what's [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] With the policy number?
[CUSTOMER][NEUTRAL] It's 023-91713.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then what's the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the total charge amount.
[CUSTOMER][NEUTRAL] It's um $1,901 even.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Mount Carmel East.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII] while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] It.
[AGENT][POSITIVE] Thank you for holding for me [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So looking at the claim, the claim number is 356.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] 4551.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was not processed because the policy lapsed in [PII] and there are no active policies on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Claim was uh not active for date of service.
[AGENT][NEUTRAL] that the policy was not active.
[CUSTOMER][NEUTRAL] May I know the policy effective and termination date?
[AGENT][NEUTRAL] This date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy lapsed the very next day, [PII], so that tells us the patient decided not to get the insurance and there's no active policies after that date.
[CUSTOMER][NEUTRAL] OK. So Pa is denied for claim was not active for the date of, for date of service and effective from [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. And uh may I know the call reference number and your name for the documentation?
[AGENT][NEUTRAL] Yes, um, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] If member is having any other insurance factor?
[AGENT][NEUTRAL] No, there are no active policies with us.
[CUSTOMER][NEUTRAL] No, not with you. Is there any other insurance active?
[AGENT][NEUTRAL] I don't know if another company has them or not with our company there are no active policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And that.
[CUSTOMER][NEUTRAL] I you.
[AGENT][NEUTRAL] OK [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, uh, no, that's it for today.
[AGENT][POSITIVE] OK well you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] OK, yeah, fine, thank you, thank you.