AccountId: 011433970860
ContactId: 575f6297-df2d-4b45-baeb-d2f8d136e470
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266040 ms
Total Talk Time (AGENT): 96884 ms
Total Talk Time (CUSTOMER): 98710 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/575f6297-df2d-4b45-baeb-d2f8d136e470_20250407T15:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APA. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for a provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purpose. Will you please spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII], [PII] my [PII] name [PII] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome, and [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Member ID is
[CUSTOMER][NEUTRAL] 1366991.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII] [PII]. Date of [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 date of service or the claim number for the claim?
[CUSTOMER][NEUTRAL] Potato services of [PII]. Bill the month of the claim is.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total bill amount is
[CUSTOMER][NEUTRAL] $370 even. 370.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Office name is Oxford After Hours Clinic PLLC.
[AGENT][NEUTRAL] OK, I think this is. Hold on one moment, just want to check the total.
[AGENT][NEUTRAL] Yeah, this is it. OK, so we received the claim.
[AGENT][NEGATIVE] And it was denied because the services were rendered after coverage was terminated. Did you need the effective and termination date?
[CUSTOMER][NEUTRAL] Yeah, claim number, please.
[AGENT][NEUTRAL] Oh, so, oh, OK, I didn't know you, did you need the whole claim status? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, just to confirm, do you also confirm the claim also denied for the same reason or not?
[AGENT][NEUTRAL] Like the date
[AGENT][NEGATIVE] The denial reason that I gave is the denial reason, um, that's the only denial reason.
[CUSTOMER][NEUTRAL] OK. Policy not active. Thank you. Effective in terms of the policy, please.
[AGENT][NEUTRAL] OK, so the claim number is 357-797-8.
[AGENT][NEUTRAL] And the policy was active from [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. When this claim was denied?
[AGENT][NEUTRAL] Hold on one moment. [PII].
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] After the update, is there any policy renewed?
[AGENT][NEUTRAL] Not with not with APL.
[CUSTOMER][NEGATIVE] Yeah, yeah. We not received any payments within the last 4 years.
[CUSTOMER][NEUTRAL] [PII], it was 25, it was denied as policy not active and no policy renewed. OK. Apart from APL is there any other insurance active to the members for the record? Is there any secondary insurance active?
[AGENT][NEUTRAL] I mean, we are, we were the secondary insurance, but once they leave us, you would have to reach out to the member to see what insurance they have.
[CUSTOMER][NEUTRAL] OK, we'll call them. Thank you. Will you please provide me the call reference number, [PII]?
[AGENT][NEUTRAL] Yes, so there's no call reference number, but you can use my name and today's date.
[AGENT][NEUTRAL] First initial of my last name is [PII]. You're welcome.
[CUSTOMER][POSITIVE] Thank you. Thanks for your assistance and.
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you. Bye for now.
[AGENT][POSITIVE] Thanks for calling APO.