AccountId: 011433970860
ContactId: 76ad5764-089e-4a84-812d-53ba7405f1d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597729 ms
Total Talk Time (AGENT): 171734 ms
Total Talk Time (CUSTOMER): 134212 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/76ad5764-089e-4a84-812d-53ba7405f1d1_20250306T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for the provider to check on a claim status. Please note this call will be monitored and recorded for the quality and training purposes. How are you doing today?
[AGENT][POSITIVE] I'm good [PII], thank you for asking. How are you?
[CUSTOMER][POSITIVE] I'm also doing great, thank you so much for asking.
[AGENT][POSITIVE] Great. I'm happy to check a claim status for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It is um D as in Delta 43729629.
[AGENT][NEUTRAL] Unfortunately, [PII], I can't pull the patient with that number. Do you have the claim number or do we have their social or name?
[CUSTOMER][NEUTRAL] Uh yes, I do have a patient's name.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Last name is [PII] in
[CUSTOMER][NEUTRAL] And date of birth, sir?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes. Date of birth is [PII]. And last name is [PII].
[AGENT][NEUTRAL] And the first name is [PII]. Is that [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you so much. And then what's the date of service?
[CUSTOMER][NEUTRAL] Sure. D of service is [PII].
[AGENT][NEUTRAL] OK, and the bill amount?
[CUSTOMER][NEUTRAL] Sure. Um,
[CUSTOMER][NEUTRAL] With the amount is $1280 even.
[AGENT][NEUTRAL] All right, let me take a look here.
[AGENT][NEUTRAL] OK, so it looks like we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like the claim was denied on [PII]. Um, our records indicate that the premium was not received for the date of service, so therefore, there were no benefits payable.
[CUSTOMER][NEUTRAL] OK. So you require supporting documents to process the claim or complete medical records?
[AGENT][NEGATIVE] Uh, no, the claim was denied because we were awaiting information for the premium. It had not been received.
[CUSTOMER][NEUTRAL] OK. So from the premium and the since you required information from the provider or the patient?
[AGENT][NEUTRAL] We were awaiting that information from the um.
[AGENT][NEUTRAL] Insured
[AGENT][NEGATIVE] Employer, so the patient wasn't um active at the time of service, premium was not received.
[CUSTOMER][NEUTRAL] OK. So uh patient was not eligible on the date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I have the, uh, effective and termination date of the policy, please?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for confirming that. And for documentation purpose, can I have the appeal mailing address, please?
[AGENT][NEUTRAL] Uh, that would be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. And for this, can I have the claim number, please?
[AGENT][NEUTRAL] That is 3504341.
[CUSTOMER][POSITIVE] OK. Thanks for that. And uh um
[CUSTOMER][NEUTRAL] Can I have the reference number for this number, please?
[AGENT][NEUTRAL] Call reference is my name with my last initial in today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] OK, thanks for that. And uh I do have one more claim to check on. Could you please assist me with that one, please?
[AGENT][NEUTRAL] Mhm. Absolutely. Is it a different patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 302203464.
[AGENT][NEUTRAL] That's not coming up as a valid policy number. Do you have their name, social, claim number?
[CUSTOMER][NEUTRAL] Sure. Uh, the patient's first name is [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And the last name, is that spelled [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] Uh, there is only one S.
[AGENT][NEUTRAL] OK, let me go back then.
[AGENT][NEUTRAL] So the first name is [PII] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not seeing anything come up by that name. Do you have a claim number or anything like that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Just give me a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I do not have any claim number.
[AGENT][NEUTRAL] All right, um, unfortunately, I'm not able to find a member policy with the information provided. The only other way I could search is by social if you have that.
[CUSTOMER][NEUTRAL] But I don't have that.
[AGENT][NEUTRAL] I don't see a member plan with us any under that information. Based off of that name and date of birth, I'm not able to locate a member plan.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Is there anything else I can check for you?
[CUSTOMER][POSITIVE] No, that's all for today. Have a great day.
[AGENT][NEUTRAL] You too bye bye.