AccountId: 011433970860
ContactId: 663b2b82-5d1b-417f-b17b-1e2755f32e53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344309 ms
Total Talk Time (AGENT): 138409 ms
Total Talk Time (CUSTOMER): 113588 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/663b2b82-5d1b-417f-b17b-1e2755f32e53_20250103T20:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII]. That is [PII] calling from provider's office to check on claims.
[AGENT][NEUTRAL] OK, sure. Can you spell your name again, please?
[CUSTOMER][NEUTRAL] Uh yeah, that is [PII] Last initial of my name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And sure, you said you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Sorry? Yes, right.
[AGENT][NEUTRAL] And I can help you with that. What is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] payment
[CUSTOMER][NEUTRAL] Uh, 2 claims.
[AGENT][NEUTRAL] OK, are they for the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, for same patient.
[AGENT][NEUTRAL] OK. So you will use my name that I gave you along with today's date as your call reference number.
[AGENT][NEUTRAL] And any information that I provide for you today will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Uh, your name is?
[CUSTOMER][NEUTRAL] OK. Uh your name is [PII]?
[AGENT][NEUTRAL] No, it's [PII]
[CUSTOMER][POSITIVE] All right. OK. Thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] 01725907
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] That is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] [PII], uh, total bill amount, $2,746 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this claim was received on 129.
[CUSTOMER][NEUTRAL] OK this is 5.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3539.
[CUSTOMER][NEUTRAL] Just a second. Just a second.
[CUSTOMER][NEUTRAL] OK. Claim number 3539.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] 950,353,539,950.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And the reason for the denial states these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. May I know the dinner?
[AGENT][NEUTRAL] This policy has a term date of [PII] and there is no other coverage with our company beyond that time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I have policy range date?
[AGENT][NEUTRAL] Effective date [PII].
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] Term date [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK. Actually there is one more claim for the same patient, just the retail service is different.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Day service in total bill amount.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That is [PII]. Bill amount is $50 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That claim was also received and denied.
[AGENT][NEUTRAL] And that claim was, do you need to receive date?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], processed and denied 125.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And the claim number is 353-778-6.
[CUSTOMER][NEUTRAL] OK. For the same reason?
[AGENT][NEUTRAL] This one states office visits are not covered.
[CUSTOMER][NEUTRAL] Office visits.
[AGENT][NEGATIVE] are not covered. Yes, this policy was not active for this state of service.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Mm, OK, then. Thank you so much. Have a great day.
[AGENT][NEUTRAL] You're welcome. And if you need a copy of either one of those explanation of that beneficiary, you can get those from our portal by going to [PII].
[CUSTOMER][POSITIVE] OK. OK, then, thank you so much.
[AGENT][POSITIVE] You're very welcome. And so thank you for calling APL if that's all I can help you with, and I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.