AccountId: 011433970860
ContactId: 541af28d-7a92-44dc-bed6-71b5fd6abe5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199779 ms
Total Talk Time (AGENT): 89768 ms
Total Talk Time (CUSTOMER): 63536 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/541af28d-7a92-44dc-bed6-71b5fd6abe5e_20250113T18:03_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office.
[AGENT][NEUTRAL] I'm sorry, can you repeat your name? I didn't quite catch your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 1,067,610
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], and date of birth [PII].
[AGENT][NEUTRAL] And how may I assist you with this number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Can you please help me with the general claim status for this one?
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service will be [PII] and the bill amount will be $34 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and for future you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we received the claim on [PII], processed [PII], and the claim was denied. The denial reason is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A claim was received on [PII], right?
[AGENT][NEUTRAL] Yes, receive [PII], process [PII].
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And denied on [PII], sorry.
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Yes. Uh, the member is not active for the date of service. And what are the effective dates?
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] OK. The effective date of the policy is [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. What is the timely limit for this one?
[AGENT][NEUTRAL] There is no timely funding limits.
[CUSTOMER][NEUTRAL] No timely falling limit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Uh, OK. Thank you so much. And can I get the claim, uh, claim number?
[AGENT][NEUTRAL] Claim number, sure. It is 354-048-1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. 3540.
[AGENT][NEUTRAL] 481. Mhm.
[CUSTOMER][NEUTRAL] 481.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else?
[CUSTOMER][POSITIVE] Thank you so much for this information.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. Have a good day, Mr. [PII]
[CUSTOMER][POSITIVE] You too. Have a wonderful day. Take care.
[AGENT][POSITIVE] Thank you you as well.