AccountId: 011433970860
ContactId: 5d9dc018-fdd1-44db-a392-0b26b6e97711
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605890 ms
Total Talk Time (AGENT): 147995 ms
Total Talk Time (CUSTOMER): 222966 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/5d9dc018-fdd1-44db-a392-0b26b6e97711_20250116T20:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII], and I'm calling for the provider to check on additional information about the claim that has been denied. Please know this call is monitored and recorded for quality and training purposes. How was your day, [PII]?
[AGENT][POSITIVE] I'm, I'm good, [PII]. Thank you so much. I'm happy to check on a claim for you. What is the policy number?
[CUSTOMER][NEUTRAL] Uh, before that, can I have your last initial?
[AGENT][NEUTRAL] T as in Tango.
[CUSTOMER][NEUTRAL] OK. T as in Tango. You want the policy number, is that right? OK, just a second. It is 02348040 M as in Mike, L as in Lima, 7.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, the callback number it is [PII] is the direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name, it will be uh [PII], sorry, I go with the date of service. It is [PII]. And the date of birth, it is [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Oh yeah, rate of service, it would be um [PII] and the charge amount will be $1960 even.
[AGENT][NEUTRAL] Do you have a build amount after the primary?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] After the primary
[CUSTOMER][NEUTRAL] Uh, just give me a second. I will verify it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I had only the same amount that is 1960.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied [PII]. Claim was denied because services were rendered after the member was active.
[CUSTOMER][NEUTRAL] Mm, actually, it was denied on [PII], is that right?
[AGENT][NEUTRAL] Let me go back one moment.
[AGENT][NEUTRAL] [PII], yes, of [PII], correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, it is denied for the reason that number is not eligible, is it right?
[AGENT][NEGATIVE] The member was not active at the time of service.
[CUSTOMER][NEUTRAL] OK, so can you just go on with the member's plan effective on termination date?
[AGENT][NEUTRAL] Members plan effective [PII].
[AGENT][NEUTRAL] Members plan terminated [PII].
[CUSTOMER][NEUTRAL] Uh, [PII]. OK, OK, OK. There is no coverage after [PII], is that right?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No coverage after [PII], correct.
[CUSTOMER][NEUTRAL] OK. Does the member have any active insurance for the data of service?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] Uh, OK, OK. Just give me a second.
[CUSTOMER][NEUTRAL] No coverage and uh there is no other active insurance.
[CUSTOMER][NEUTRAL] OK. Actually, I had 2 more clients. Can you just help me with that also?
[AGENT][NEUTRAL] Same patient or different?
[CUSTOMER][NEUTRAL] Oh, it's a different patient. Uh, before going to that, can you just provide me the call reference for this one so we can move to the next.
[AGENT][NEUTRAL] Call reference would be my name with my last initial than today's date.
[CUSTOMER][NEUTRAL] OK. 1116, sorry, I have mentioned 1101162025. OK, thank you so much. Yeah. Just a second, I will go with the next member ID.
[CUSTOMER][NEUTRAL] I want to start with the member ID or the NPI?
[AGENT][NEUTRAL] Go ahead with the member ID.
[CUSTOMER][POSITIVE] OK, thank you so much. Just a second.
[CUSTOMER][NEUTRAL] It is 02141251, M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it will be [PII], and the date of birth, it is [PII].
[AGENT][NEUTRAL] OK data service.
[CUSTOMER][NEUTRAL] Oh yeah, it is [PII] and the charge amount will be uh $616 even.
[AGENT][NEUTRAL] My mama.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, you can go on with the effective on the termination date as well.
[AGENT][NEUTRAL] Effective date was [PII].
[AGENT][NEUTRAL] And the termination date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], this is again.
[CUSTOMER][NEUTRAL] [PII]. OK. So that after that, there is no coverage. OK. And does the member have any active insurance for the service?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK, no problem. So for this one, the call will be the same. I will go with the last member ID, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, just a second. I'm just pulling it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, the member ID it is 01471062 [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name will be, uh, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] You have service it is on [PII] and the charging one will be $180 even.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Claimants received [PII], denied [PII]. Services were rendered after the policy was active.
[AGENT][NEUTRAL] Uh, the effective date on this policy [PII].
[AGENT][NEUTRAL] Policy terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII] and uh turned on [PII]. OK. Just a second. Uh, when is the direct service date?
[CUSTOMER][NEUTRAL] So falls on [PII]. OK, OK.
[CUSTOMER][NEUTRAL] OK. Does have any active insurance?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK, no problem. So the call reference will be the same which you have provided, is it right for the previous one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][POSITIVE] Bye-bye. Thank you.