AccountId: 011433970860
ContactId: 6bdb8502-5c7f-4a15-b13f-d4ebf3525a0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460100 ms
Total Talk Time (AGENT): 104200 ms
Total Talk Time (CUSTOMER): 248035 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/6bdb8502-5c7f-4a15-b13f-d4ebf3525a0c_20250220T17:45_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] For calling APL, my name is [PII]. How may I?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I'm calling about a couple of claims I have that had a rough time trying to find y'all phone number, but somebody gave it to me that I called last time.
[AGENT][POSITIVE] Oh, OK, I'm sorry for the inconvenience. I'd be happy to assist with some claims today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] OK, I'll start.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEGATIVE] I don't want
[CUSTOMER][NEUTRAL] Um, D 437-079-993.
[AGENT][NEUTRAL] OK, I believe that's their wellness policy number. Do you have a social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, don't know that. Let me see.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Eah [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you calling for medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, thank you for that information and what is the date of service for the claim?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] What is the data
[CUSTOMER][NEUTRAL] I got one for.
[CUSTOMER][NEUTRAL] [PII] and then I've got one for [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And it goes back to base.
[AGENT][POSITIVE] Thank you for that information, one moment.
[AGENT][NEUTRAL] OK, so it looks as though this claim denied because the date of service was prior to her effective date. Looks like her effective date was [PII].
[CUSTOMER][NEUTRAL] Not because the data services to the [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK, so this one is the [PII], and did she have no coverage before?
[CUSTOMER][NEUTRAL] Each vacuum that
[AGENT][NEUTRAL] No. Her coverage started at [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] It's not great.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Her coverage started [PII].
[CUSTOMER][NEUTRAL] Right, but there's no coverage prior to that date.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, because I talked to a different company they're the ones that gave me your number and they said, well, they, she was covered by them but just for some kind of different.
[CUSTOMER][NEUTRAL] I don't know. I spoke to Elixir no multi plan I guess they were, um, MAU Workforce Solutions, and they're like, oh call this other place because.
[AGENT][NEUTRAL] Oh, they're talking about.
[AGENT][NEUTRAL] OK, well, I'm.
[CUSTOMER][NEUTRAL] Because she says they have a certain number of visits they're allowed there because that was the [PII] and then I've also got this one for the other date of service which was [PII].
[AGENT][NEUTRAL] Now she was covered back in from [PII] and then her coverage picked back up [PII] but it it wasn't relevant to the data service that you gave me so.
[CUSTOMER][NEUTRAL] Now she was covered back in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, how about the 111 that y'all denied as well?
[AGENT][NEUTRAL] Well, the 1/11, that you didn't give me a [PII] date. The first date you gave me was the [PII] and I saw what I was saying.
[CUSTOMER][NEUTRAL] Well, the [PII]
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] You didn't give me a [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] She wasn't covered then because her coverage started on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The [PII]. OK, so that was the [PII] then let me, what was that other date then I had [PII] and [PII], that's right.
[AGENT][NEUTRAL] Now for [PII] I'm showing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was a charge for an inpatient?
[AGENT][NEUTRAL] Visitar.
[CUSTOMER][NEUTRAL] I don't know hang on let me look.
[CUSTOMER][NEUTRAL] No, that was uh
[CUSTOMER][NEUTRAL] It looks like an outpatient.
[CUSTOMER][NEUTRAL] OK, wait a minute now, maybe I'm not real sure.
[CUSTOMER][NEUTRAL] This looks like let me look here at the notes and see what it says because this was just noninvasive imaging radiology $1300. Let me see what that was for.
[CUSTOMER][NEUTRAL] 116.
[CUSTOMER][NEUTRAL] I don't know if she was an inpatient there or not let me see.
[CUSTOMER][NEUTRAL] I don't think this was inpatient.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] 116 yep, it was inpatient.
[AGENT][NEUTRAL] OK, yeah, so that denied those charges are not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Oh, it doesn't cover inpatient.
[AGENT][NEUTRAL] Um, not inpatient, um, visit charges for the doctor. Doctor inpatient visits are not covered.
[CUSTOMER][NEUTRAL] Um, not
[CUSTOMER][NEUTRAL] Doctor inpatient visits.
[CUSTOMER][NEUTRAL] Does not cover doctor and patient visits.
[CUSTOMER][NEUTRAL] And this was actually for.
[CUSTOMER][NEUTRAL] Some anesthesia for that day, but that, that just counts as as a doctor visit.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, alright, well I'll build the patient for both then thank you so much. Can I get a reference number, [PII]? Just a reference please.
[AGENT][NEUTRAL] Is there anything else I can assist you today?
[AGENT][NEUTRAL] Reference is just my name, just my name and today's date and time.
[CUSTOMER][NEUTRAL] OK, OK, great, all right, let me make sure this one last one isn't yours, um.
[CUSTOMER][POSITIVE] No, that's Transamerica. OK, all right, thank you, have a good weekend.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Uh huh thanks bye bye.
[AGENT][NEUTRAL] Mm.