AccountId: 011433970860
ContactId: 59d3653f-2058-4bc4-8c5e-c4dbb2ca6880
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376859 ms
Total Talk Time (AGENT): 82571 ms
Total Talk Time (CUSTOMER): 129538 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/59d3653f-2058-4bc4-8c5e-c4dbb2ca6880_20250417T19:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], this is [PII] calling from provider's office working on claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, it's 1,449,360. M as in Mike, L as in Lima, 5.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the charge amount is $5,257 even.
[CUSTOMER][NEUTRAL] 5257
[AGENT][NEUTRAL] Um, it was December, I'm sorry, what date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, it looks like these services were rendered after a policy terminated.
[CUSTOMER][NEUTRAL] Uh, so, uh, may I know when did the, the policy was terminated?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, so the patient plan already was um.
[AGENT][NEUTRAL] Yeah, let me make sure there's not a different policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, this is the only policy that we have on file and it did turn [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I have the effective date also?
[AGENT][NEUTRAL] Effective date [PII].
[CUSTOMER][NEUTRAL] OK. And uh have you received this claim?
[AGENT][NEGATIVE] Yes, we denied it.
[CUSTOMER][NEUTRAL] May I know the receipt and uh processed date also?
[AGENT][NEUTRAL] OK, [PII], denied [PII].
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] 355-22229.
[CUSTOMER][NEUTRAL] OK. And uh can you fax the UB to us if possible?
[AGENT][NEUTRAL] Yes, which facts.
[CUSTOMER][NEUTRAL] Yeah, it's, uh, actually, uh, give me one second. I just want to know uh the claim number is 3552229.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Actually, we have the portal. I just want to, a claim number so I can get easily on the portal. OK. Can we go for the next number and before that, we have the call reference number for this patient?
[AGENT][NEUTRAL] Uh, call reference is my name, [PII], first initial to last name, [PII], today's date, and then let me note this real quick.
[CUSTOMER][POSITIVE] OK, yeah, can we go for an extra member?
[AGENT][NEUTRAL] Uh, hold on one moment
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, next policy number.
[CUSTOMER][NEUTRAL] Uh yes, it's uh 01887307 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] Yes, it's [PII], with the charge amount is $4210 even.
[AGENT][NEUTRAL] OK, looks like, let's see.
[AGENT][NEUTRAL] OK, looks like we received that on [PII], process [PII], and denied for services for after term date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this is uh was rendered after the uh, OK, so it was the same denied. May I have the effect, may I have the claim number?
[AGENT][NEUTRAL] Claim number 357.
[AGENT][NEUTRAL] 851-3.
[CUSTOMER][NEUTRAL] OK. May I have the affective and term date too?
[AGENT][NEUTRAL] [PII], Terminated [PII].
[CUSTOMER][POSITIVE] OK. And uh yeah, actually, I'm done. That's the only claim I have prior to today's call and thank you so much for your help.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too, bye.