AccountId: 011433970860
ContactId: 528787c8-b248-4c9d-a8d2-9c441154606d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627400 ms
Total Talk Time (AGENT): 198152 ms
Total Talk Time (CUSTOMER): 178575 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/528787c8-b248-4c9d-a8d2-9c441154606d_20250606T15:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, hi, uh, this is [PII] calling from provider's office to check on status.
[AGENT][NEUTRAL] Mhm, sure, I can assist you with claim status since [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] What's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, yeah, this is CJW Medical Center.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number will be 01648436.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the name will be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and charges will be $6,391 and even.
[AGENT][NEUTRAL] OK. And that's [PII] $6,391 even, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, before that I want to ask one thing. How are you doing today?
[AGENT][POSITIVE] I'm good thank you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I'm doing good too.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, and OK, so here's the claim, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like we need the primary explanation of benefits to continue the processing of this claim this June.
[CUSTOMER][NEUTRAL] OK. May I have the receipt date of the claim?
[AGENT][NEUTRAL] Mhm. Sure. Let me get that for you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, that's.
[AGENT][NEUTRAL] OK, one moment. That's not on the EOB so let me look for that receipt date.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so we received the claim on [PII] and process on [PII].
[CUSTOMER][NEUTRAL] So it has been uh
[CUSTOMER][NEUTRAL] Or is on [PII], correct?
[AGENT][NEUTRAL] It was processed on [PII], received on [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK. So it has been denied for primary UV?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, I think we have already been sent to the primary UV through fax. Could you please check on that?
[AGENT][NEUTRAL] When did you send? I didn't find anything else for that date of service. What day did you send that fax?
[CUSTOMER][NEUTRAL] Uh yeah, it has been faxed on for [PII].
[AGENT][NEUTRAL] Mm we have not received that fax as of today.
[CUSTOMER][NEUTRAL] To be your address, so is that OK to resend it?
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] You want to verify that fax number?
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Do you need me to give it to you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Oh, is that, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you please continue?
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thanks for that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And may I have your uh name and the call reference number once again?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. The spelling of my name is [PII]. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, I do have another bill. Could you please check on that?
[AGENT][NEUTRAL] Is it for a different member or the same member?
[CUSTOMER][NEUTRAL] I have to
[CUSTOMER][NEUTRAL] Uh, different number.
[AGENT][NEUTRAL] OK, bear with me just a minute let me finalize the note on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK. What is the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 0123392 M as in Mary, L as in Lima.
[AGENT][NEUTRAL] Can you repeat it? It kind of broke up in the middle of that number.
[CUSTOMER][NEUTRAL] 0172.
[CUSTOMER][NEUTRAL] 92 M as in Mary, L as in Lima.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me repeat what I'm hearing, OK? Let me make sure I got it correctly. 0172392.
[AGENT][NEUTRAL] ML8.
[CUSTOMER][NEUTRAL] Uh, that is 3392.
[AGENT][NEUTRAL] 3392. OK, so 01723392 MLA.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the name will be uh [PII], sorry, that is [PII] will be the first name and the last name will be [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the, the date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] The date of
[CUSTOMER][NEUTRAL] Service will be [PII].
[CUSTOMER][NEUTRAL] And charges will be $3,344 and even.
[AGENT][NEUTRAL] OK, [PII], the amount of 3,344. Let me see if I can find this claim.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so it looks like we received this claim on [PII], processed [PII], and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Uh, so, could you please give me an explanation so it has been denied for?
[AGENT][NEUTRAL] The service was surrendered after coverage was terminated. The policy got terminated [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is that the member ID which I gave is correct?
[AGENT][NEUTRAL] Yes, it is correct. There's no other policies. This is the last policy we have for this member. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thanks for that. Uh, and may I have your name, please?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh, so you don't have call uh reference number, right? And thank you for that, [PII] and have a good day.
[AGENT][POSITIVE] You as well and thank you for calling APR. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm, OK.