AccountId: 011433970860
ContactId: 86eec60a-49f3-4ea7-a0b5-d8de47b428fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306399 ms
Total Talk Time (AGENT): 147352 ms
Total Talk Time (CUSTOMER): 140310 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/86eec60a-49f3-4ea7-a0b5-d8de47b428fb_20250103T14:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Park View, uh, Health Hospital up in [PII]. I'm just needing to get the eligibility dates of a patient that we have on file.
[AGENT][NEUTRAL] OK. Well, I can definitely help you with the eligibility. And [PII], may I have a good contact number just in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02.
[CUSTOMER][NEUTRAL] 276-561. It looks like it might be terminated, so we're just needing to get the end data service on her termination.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment. And yes, I am showing it's no longer active. Um, it was effective from [PII].
[CUSTOMER][NEUTRAL] OK, that is exactly what I needed. So you said [PII]. OK, um, then can you look, we sent a claim and it got denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's
[CUSTOMER][NEUTRAL] Stating that the coverage was termed or like the policy premium hadn't been paid.
[AGENT][NEUTRAL] What's the um data of service for the claim? I can look it up with the data service or if you have the claim number.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Um, yes, I have the claim number. It is 347-532-7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 347. Hold on one moment.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] 5327 here it is.
[AGENT][NEUTRAL] OK, so I just located it. Let me see what the reason was.
[AGENT][NEUTRAL] OK, yes. So the, so that claim was denied um because the premium had not been received for that, that covered this date of service.
[CUSTOMER][NEUTRAL] OK, so she didn't pay her premium.
[CUSTOMER][NEUTRAL] But you guys show her coverage didn't turn until July?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that data service was prior to that.
[CUSTOMER][NEGATIVE] So I'm a little confused.
[AGENT][NEUTRAL] So the type of um insurance that she has, this is like a temp agency, so we have to check weekly to see, you know, how it, how can I explain it like temp services, you know, they can be working one week and then not working the next, so we have to check with the employer weekly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So she, she technically wouldn't have been eligible that week because she didn't pay the premiums for that week is what you're stating.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, even though her term date wasn't until [PII], that's probably the date that she actually termed with the temp agency.
[AGENT][NEUTRAL] Well, no, so, oh, I see where you're confused. OK, so the policy was active the whole time, but claims coming in, if she hadn't paid the premium to us, we can't pay out. So, yes, the policy was active, but we didn't receive premium for that week because we received it weekly. So we didn't receive it for that week to be able to cover your data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I guess my next question is, yeah, they don't go back and pull for that week, do they?
[AGENT][NEUTRAL] Did I, did that help?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So like say she works the next week.
[AGENT][NEUTRAL] Uh, sometimes they
[AGENT][NEUTRAL] Sometimes they do if they're trying to keep the policy active, but since it's lapsed, I don't think it would, it probably won't.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, I will put that in there and then can I get your name again? I'm sorry.
[AGENT][NEUTRAL] Sure, my name is [PII] The [PII].
[CUSTOMER][POSITIVE] OK, I greatly appreciate it, [PII]. You have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also and thanks for calling APL and [PII].
[CUSTOMER][POSITIVE] Happy [PII]. It's the weekend, thank goodness.
[AGENT][POSITIVE] Thank you. It's the weekend.
[CUSTOMER][NEUTRAL] I know I'm thinking, oh, we don't, we don't get all those extra days now so back to regular work week.
[AGENT][POSITIVE] Have a good day.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Meanwhile, the kids are out for 3 weeks.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh, she, yeah, I know like all of ours go back Monday, so um I don't have my kids are grown.
[AGENT][POSITIVE] Good. Well, y'all are ours.
[AGENT][NEUTRAL] Ours don't go back until the [PII] and when my little one wakes up, she comes and camps out under my desk to work with me. So I'm like, when does school start?
[CUSTOMER][NEUTRAL] Uh, my little one is my English bulldog, and that's what he's doing.
[CUSTOMER][POSITIVE] Snoring away. Yeah, I know my husband's been off too. He goes back Monday too, and I'm like, thank [PII], my house will get back to normal.
[AGENT][POSITIVE] You have some peace and some me time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's right. That's right. Well, it was great to talk to you. You have a great [PII] also.
[AGENT][POSITIVE] Thank you. Have a great weekend, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.