AccountId: 011433970860
ContactId: 665cf2b0-70b6-4e8a-8929-7691c9bb1861
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276220 ms
Total Talk Time (AGENT): 71618 ms
Total Talk Time (CUSTOMER): 102078 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/665cf2b0-70b6-4e8a-8929-7691c9bb1861_20250506T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office, checking on a claim status, please.
[AGENT][NEUTRAL] OK, I can help you with claim status, and I missed your name. What was that?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] It's [PII] Last name initial [PII]
[AGENT][NEUTRAL] OK, [PII], uh, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, the policy number is.
[CUSTOMER][NEUTRAL] 01678723 M as in Mike.
[AGENT][NEUTRAL] And you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the bill amount is 1, it is $517.58.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Uh, looks like we received that claim on 3-24-25.
[AGENT][NEUTRAL] This process 3 26 25.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Uh it's 358.
[AGENT][NEUTRAL] 08887.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So it looks like actually this policy terminated [PII]. Let me see if there's a current policy.
[AGENT][NEUTRAL] Yeah, so it looks like this policy is terminated 11-1-2024, so it was after the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Effective from like the, the, what is the starting?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK. So, as a policy is terminated, so you can uh pay, right? Uh, and it would be a patient's responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're secondary.
[CUSTOMER][NEUTRAL] OK. Right. But, uh, just a moment. As, as you're saying that it has been, um, the like a primary has paid and the second as secondary you're saying the claim has, uh, as the policy has been expired.
[CUSTOMER][NEUTRAL] So it will, uh, it would be a member's responsibility, right, if it is not being paid by secondary.
[AGENT][NEUTRAL] We can't tell you if it's members responsibility or not, we can just process according to the policy.
[AGENT][NEUTRAL] So there's no coverage in effect, so it was the night.
[CUSTOMER][NEUTRAL] As no, yeah, OK, I understood it's uh, denied, but you're saying that there is no policy effective, right? That's the thing like if it, there is no policy, the claim would not process rate.
[AGENT][NEGATIVE] Yes, it's been denied because there's no coverage.
[CUSTOMER][NEUTRAL] OK, right, can I have a call reference number?
[AGENT][NEUTRAL] That's my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, is there is a you can be faxed for this?
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][POSITIVE] I'm done. Thank you, [PII].
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.