AccountId: 011433970860
ContactId: 67bcff17-8ed6-4979-bd0d-74a56d237e94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225779 ms
Total Talk Time (AGENT): 114247 ms
Total Talk Time (CUSTOMER): 59253 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/67bcff17-8ed6-4979-bd0d-74a56d237e94_20250107T15:01_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from King's physician Service, and I'm trying to get information on a claim that was denied.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. Can you spell your name for me, please?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 024856551
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Currency K 521 94.
[AGENT][NEUTRAL] OK, thank you. Um, do you have uh the claim number or you have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] I have the data services $72724 for $43.
[AGENT][NEUTRAL] OK, right, let me pull that information.
[AGENT][NEUTRAL] And Ms. [PII], I just need to let you know that for the future, you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] All right, and here it is.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] OK, let me go ahead and pull the original one. It looks like it's been processed 3 times. The last 2 times was processed and denied as a duplicate. Um, so let me go ahead and see.
[AGENT][NEUTRAL] What's the original.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, here it is. OK, we processed the claim originally on [PII], and it was denied indicating that the premium for the date of service was not received, therefore benefits are not payable. The denial still stands.
[CUSTOMER][NEUTRAL] What is the reason?
[CUSTOMER][NEUTRAL] What is the premium?
[AGENT][NEGATIVE] And the policy was not paid for the date of service. Therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK, I, I really do not understand what that means. um, what do you mean by the premium, um.
[CUSTOMER][NEUTRAL] The is the patient responsible for the bill? That's what I'm trying to understand.
[AGENT][NEGATIVE] Basically, it's not gonna be payable by us because we did not receive what we needed to receive to continue the the processing of the claim.
[CUSTOMER][NEUTRAL] You didn't receive it from whom, the patient or from us?
[AGENT][NEUTRAL] The patient, the patient.
[CUSTOMER][NEUTRAL] So the patient did not pay for the, for, I don't know the.
[AGENT][POSITIVE] For the policy. Correct.
[CUSTOMER][NEUTRAL] The premium, right?
[CUSTOMER][NEUTRAL] Oh, for the policy. OK, now I don't understand. There's something that between you and the patient that um missing information, OK. Um, can I have a reference?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no, no, no, no, not from you. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, can I have a reference number, please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Ms. [PII].
[CUSTOMER][POSITIVE] Thank you. Have a good day.
[AGENT][POSITIVE] You as well. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] Thank you for calling ATL. Have a good day bye bye.
[CUSTOMER][NEUTRAL] Mm.