AccountId: 011433970860
ContactId: 91e040b5-f011-4a61-ad99-686eefea39b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287160 ms
Total Talk Time (AGENT): 102011 ms
Total Talk Time (CUSTOMER): 159498 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/91e040b5-f011-4a61-ad99-686eefea39b5_20250210T14:57_UTC.wav
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[AGENT][NEUTRAL] Contacting APO my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. This is [PII] and I'm calling for Emergen Orthop PA to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I already checked your portal have information on the claim. So how are you doing today, [PII]?
[AGENT][NEUTRAL] I'm fine today. Um, uh, [PII], what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Yeah, so then uh policy number going to be 02230064 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient name going to be uh [PII].
[AGENT][NEUTRAL] OK, thank you. And his date of birth?
[CUSTOMER][NEUTRAL] The date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number going to be [PII] and it's direct line. There is no extension, [PII].
[AGENT][NEUTRAL] Thank you. Now you said that there was a claim that we needed to look up um what is that data service, please?
[CUSTOMER][NEUTRAL] Yes, so the date of service is going to be [PII] with the bill amount, $220. 72 cents.
[AGENT][NEUTRAL] OK, [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Well, now we have a letter that was sent out on [PII], and the date of service was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is, is maybe that what what we're looking at?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. Just to sorry for, sorry for that really it's, uh, sorry for that information. That is going to be 18 0 sorry I'm really sorry for that.
[AGENT][NEUTRAL] That's fine. Um, so it looks like that the policy lapsed.
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] As of [PII].
[CUSTOMER][NEUTRAL] And the
[AGENT][NEUTRAL] Um, now, we did check to see if they had another policy with us. Uh, they did not, um, but that is what the denial is, is because, uh, their policy was only active from [PII] until [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My number is 1073.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 7107.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, since the day of service was, uh, in [PII], uh, then their policy isn't active. They get this to their employer, so it could be that [PII] just has a different employer, um, and, and.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it may have to say like that this uh uh the policy was, uh, term on that date of service, correct?
[AGENT][NEUTRAL] That's correct, yes, it was inactive on the data service. That's exactly it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the policy uh effective on [PII], uh, policy, uh date time is going to be [PII], correct?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Mhm. Policy term on OK, no worries, and you just break me out to document that thing because primary process and secondary term. OK. Mhm. So, uh, from your end, you see any patient has any other insurance on the second day.
[AGENT][NEUTRAL] Uh, I don't, I don't show anything else. The only thing I, I have is just ours, which is, uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm. Because from my end, I just see here the patient has two plans, primary as UC and the second one is uh APLI. That's why. OK, no worries.
[AGENT][NEUTRAL] Which is lapsed.
[CUSTOMER][NEUTRAL] Uh, [PII] policy term one.
[CUSTOMER][NEUTRAL] OK, no worries. Just bear with me. I do document that thing. One second.
[CUSTOMER][NEUTRAL] OK, and [PII], you don't see any active, any other active insurance from and well, correct?
[AGENT][NEUTRAL] Uh, no, I'm sorry, I don't.
[CUSTOMER][POSITIVE] Yeah, yeah, just know, so now I just sent me the call from some offer good call.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Mhm. [PII] [PII]. Got it. No worries. Thank you for your assistance, [PII], and have a nice day. Bye bye for now.
[AGENT][NEUTRAL] If there's nothing else I can help with, thank you for contacting AC I have a.