AccountId: 011433970860
ContactId: 9038db74-94c3-4943-9765-88397bbe0429
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303040 ms
Total Talk Time (AGENT): 124995 ms
Total Talk Time (CUSTOMER): 63360 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/9038db74-94c3-4943-9765-88397bbe0429_20250204T15:38_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you need to check claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] the direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] It's 02540055.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment, [PII]. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $182.40.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is going to be 3555151.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] The reason for the denial on this claim?
[AGENT][NEUTRAL] States
[AGENT][NEUTRAL] Our records indicate that premium for this service date was not received. Therefore, benefits are not payable. This policy has a termination date of [PII].
[AGENT][NEUTRAL] And there is no other active for your data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we know from when the member was effective as well.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And um or no.
[CUSTOMER][NEUTRAL] [PII]. And may I know when was the last call updated?
[AGENT][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] There is no COV on this policy. We are not a major medical insurance company. This is, this plan that she had with us was a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may go to our portal, [PII] to print that.
[AGENT][POSITIVE] And our portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Thank you, [PII]. Thank you for that. So the premium for the data service has been terminated.
[AGENT][POSITIVE] You're certainly welcome.
[AGENT][NEGATIVE] Yes, it was not received. Premium for this data service was not received. This policy termed 11-10-2024.
[CUSTOMER][NEUTRAL] Got it. And can I get a call reference number for today's call?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][POSITIVE] Thank you. Have a wonderful day.
[AGENT][POSITIVE] Yes, ma'am. I hope you do too, [PII]. That's all I can help you with. Thank you again for calling APL.