AccountId: 011433970860
ContactId: 7c55da4d-bf0e-4083-8f1e-d6e1983d1e72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398950 ms
Total Talk Time (AGENT): 139546 ms
Total Talk Time (CUSTOMER): 129221 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/7c55da4d-bf0e-4083-8f1e-d6e1983d1e72_20250205T21:36_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I was calling to check on the status of a claim.
[AGENT][NEUTRAL] OK, I can help you. What's your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] It is 23463667.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And I'm sorry, your, your name is [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You gave me policy 2346367 or 6537.
[CUSTOMER][NEUTRAL] I'm sorry, 2346367.
[AGENT][NEUTRAL] I'm fine, that's a different patient.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2346 367. Let me make sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient is [PII], and middle initial [PII] Last name, date of birth is [PII].
[AGENT][NEUTRAL] Spell the first name for me, [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And you are a medical provider?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I think it's 6376.
[CUSTOMER][NEUTRAL] Oh, so we don't have it correct.
[AGENT][NEUTRAL] Yeah, that's 6 and 7.
[CUSTOMER][NEUTRAL] Oh, they have the, the last uh digits.
[AGENT][NEUTRAL] Transposed. Mhm.
[CUSTOMER][NEUTRAL] Yeah. Oh well, OK.
[AGENT][NEUTRAL] Yes, and verify that date of birth for me again.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, yeah, so the policy number is 2346376.
[CUSTOMER][NEUTRAL] Let me pull up the 4.
[AGENT][NEUTRAL] And so we're checking claim status for what day?
[CUSTOMER][NEUTRAL] Um, one second because it you guys may not have it now that we don't have it.
[AGENT][NEUTRAL] Oh, OK
[CUSTOMER][NEUTRAL] OK, um, the data service for [PII] is.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] You're OK. Um, 1223, 2024.
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEGATIVE] Actually, it looked like it denied.
[AGENT][NEUTRAL] OK, what's the amount?
[CUSTOMER][NEUTRAL] Um, $208 even.
[AGENT][NEUTRAL] 208.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah, I see the claim.
[AGENT][NEUTRAL] So we did receive it.
[AGENT][NEUTRAL] And what's the provider's name?
[CUSTOMER][NEUTRAL] The billing provider is [PII].
[CUSTOMER][NEUTRAL] Blacker.
[AGENT][NEUTRAL] Su sumo physicians.
[CUSTOMER][NEUTRAL] So, yeah, so my physicians.
[AGENT][NEUTRAL] OK. So.
[AGENT][NEUTRAL] Let's see 1223 24.
[AGENT][NEGATIVE] So no payment was made. It says our records indicate the premium for this service date was not received. Therefore benefits are not payable.
[AGENT][NEUTRAL] So the the uh patient was ineligible for this state of service.
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] You said what wasn't received?
[AGENT][NEUTRAL] Premiums
[CUSTOMER][NEUTRAL] Oh, premium.
[AGENT][NEUTRAL] Yeah, so for this state of service this policy is active, um, but we didn't receive premiums for this week this this this date, uh, fell within a week that we didn't receive premiums.
[AGENT][NEGATIVE] And so we were not able to pay this.
[CUSTOMER][NEUTRAL] So the patient is responsible for the balance.
[AGENT][NEUTRAL] Well, we can't determine, you know, we don't determine the responsibility, but you know, going with the, the denial, the denial reason, it's not payable by this policy.
[CUSTOMER][NEUTRAL] Because according to the den now on our end, it's showing that there is lack info needed for adjudication.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Or has submission billing errors, so it doesn't say anything about not covered for the data service or anything like that.
[AGENT][NEUTRAL] Yeah, that's what's on the back of our explanation of benefits which should have been, it was, you know, sent to Suma.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Physician Inc.
[CUSTOMER][NEUTRAL] So you say, so you stay in the premium for data service I received.
[AGENT][NEUTRAL] Right, he was basically, basically he was ineligible for this date of service for this day, the [PII].
[CUSTOMER][NEUTRAL] For that week.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any other questions, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, that's it, can you provide a reference number?
[AGENT][NEUTRAL] Mhm. You'll use my, you'll use my name in today's date as your reference. [PII] initial of my last name is [PII].
[CUSTOMER][NEUTRAL] For the call.
[CUSTOMER][POSITIVE] OK, great. Thank you so much, [PII].
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.