AccountId: 011433970860
ContactId: 94574089-1e83-4f67-b2e8-a680122a27f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349609 ms
Total Talk Time (AGENT): 134736 ms
Total Talk Time (CUSTOMER): 119551 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/94574089-1e83-4f67-b2e8-a680122a27f5_20250203T20:19_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And I am calling today um to get clarification on a claim.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to assist you with the claim clarification. And [PII], are you the insured or you're calling with a group or provider?
[CUSTOMER][NEUTRAL] I am calling today from Lord's Hospital with the uh facility.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02463908.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], that's how you pronounce that, um, [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes ma'am, this is for $59 or $24 in the bill amount of $40,594.18. We got a remit, but the only thing that is showing on the remit is actually the claim number, that is it. We actually got two remits and both remits are just showing claim numbers, nothing else.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Lord's Hospital, L O U R D E S.
[AGENT][NEUTRAL] Here it is. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So I'm waiting for the EOB to populate.
[AGENT][NEUTRAL] OK, um, so the reason that the, so you don't have like the reasoning or anything is just the claim number, you said?
[CUSTOMER][NEUTRAL] There's nothing, not even numbers, it's just a claim number, yes ma'am, I've got claim number 3477585 and that's all the showing.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you want me to fax this over to you?
[CUSTOMER][POSITIVE] That would be fantastic, yes, ma'am. My fax number is [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Yes and that'll be fine. And can I just get information since I've already got you on the phone in case I have questions?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so the reason the claim was the, the, so do you need like the date was received and denied and everything?
[CUSTOMER][POSITIVE] That would be great, yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] And that claim number is 349.
[AGENT][NEUTRAL] 481 9.
[CUSTOMER][NEUTRAL] Oh that's a different claim number than what I got, OK.
[AGENT][NEUTRAL] I'm sorry, hold on, and you're right. I, I was looking at the wrong line. I'm sorry.
[AGENT][NEUTRAL] Um, you can disregard that. Um, it's the one below it, my apologies.
[AGENT][NEUTRAL] So you received it on [PII]?
[AGENT][NEUTRAL] Claim number is 347.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 758 5.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because our records indicate that premium for this service date was not received, therefore benefits are not payable.
[CUSTOMER][NEGATIVE] OK, so they didn't meet their requirements.
[CUSTOMER][NEUTRAL] To have coverage, in other words.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] OK and um so this is patient responsibility.
[AGENT][NEUTRAL] Well, now we don't determine patient responsibility because we're not the major, we're not a major medical, um.
[AGENT][NEUTRAL] So we don't give that part out. Uh, that's why it's not on the explanation of benefits, unfortunately. It would just be whatever your um procedures are with outstanding balances.
[CUSTOMER][NEUTRAL] Alright, well I will reach out to my supervisor, but I'm sure if y'all are not considered major medical and if that is on your insurance card.
[CUSTOMER][NEUTRAL] I believe we just removed your insurance from our.
[CUSTOMER][NEUTRAL] Computer anyway, but I will ask and verify.
[CUSTOMER][POSITIVE] Um, I appreciate you and you got that faxed over.
[AGENT][POSITIVE] You're very welcome and yes, I did fax that over to you, so you should be receiving that shortly. There's no call reference number, you can use my name in today's date.
[CUSTOMER][NEUTRAL] Call reference?
[CUSTOMER][NEUTRAL] Your first initial to your last name is [PII]?
[AGENT][NEUTRAL] It's [PII] like [PII].
[CUSTOMER][POSITIVE] Thank you so much. I hope you have a fantastic day.
[AGENT][POSITIVE] Thank you, [PII]. You also, and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.