AccountId: 011433970860
ContactId: 56fcf661-3a70-4ce3-aa9b-0bb3b24baad3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205809 ms
Total Talk Time (AGENT): 66515 ms
Total Talk Time (CUSTOMER): 88945 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/56fcf661-3a70-4ce3-aa9b-0bb3b24baad3_20250409T15:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for provider office to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes. Can you spell your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII] And can you spell your first name and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes. My name is [PII] and last name is [PII]. Callback number [PII] is your direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, policy number, it is 023315-95 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient name, address, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No. [PII].
[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 claim number for the claim you'd like to go over today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] Or the data service.
[CUSTOMER][NEUTRAL] Claim number it is 3.
[CUSTOMER][NEUTRAL] Uh, claim number, it is 3579396. Uh, 1 moment. Claim number it is 35793667.
[AGENT][NEUTRAL] OK, and the claim was denied because the services were rendered after coverage was terminated and what questions did you have?
[CUSTOMER][NEUTRAL] Yes, I think the claim has been needed for our patient expenses. May I, can I get the member's effective date?
[AGENT][NEUTRAL] Yes, this policy was effective from [PII].
[CUSTOMER][NEUTRAL] Just to confirm effect you want.
[CUSTOMER][NEUTRAL] [PII] and terminated on [PII]. Is that right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And does the member has any other act to insurance?
[AGENT][NEUTRAL] Not with APL.
[CUSTOMER][NEUTRAL] No other insurance, am I right?
[AGENT][NEUTRAL] If there is, you have to reach out to the members to see who their insurance is, they don't have any with APL so we can't see any others.
[CUSTOMER][NEUTRAL] And can I get the reference number for this call?
[AGENT][NEUTRAL] Sure. So there's no call reference number, but you can use my name and today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And today's date, Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. And thank you for assisting me today. Have a great day. Bye.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] All