AccountId: 011433970860
ContactId: 9489eba7-265c-4eb7-ac9d-179c9af6f527
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 590640 ms
Total Talk Time (AGENT): 142395 ms
Total Talk Time (CUSTOMER): 221199 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/9489eba7-265c-4eb7-ac9d-179c9af6f527_20250321T16:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Last name initial is [PII] to check on our claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Order number [PII] [PII].
[AGENT][NEUTRAL] Thank you [PII] what is uh the patient's name, date of birth and policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. Patient's first name is going to be [PII]. Last name is [PII]. Date of birth [PII]. And the policy number is going to be 353648697.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, that is not one of our policy numbers. Do you see another policy number?
[CUSTOMER][NEUTRAL] Um, no.
[CUSTOMER][NEUTRAL] Uh, let me double check. One second.
[AGENT][NEUTRAL] OK. Yes, sir.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] Yeah, the subscriber ID will be 353648697.
[CUSTOMER][NEUTRAL] That is the ID which I have.
[AGENT][NEUTRAL] 343-648-697.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's not one of
[CUSTOMER][NEUTRAL] For American public life.
[AGENT][NEUTRAL] Right, that's not one of our numbers. um, can you have the patient's first name for me?
[CUSTOMER][NEUTRAL] Yes. First name is spelled as [PII]. Last name is spelled as [PII].
[AGENT][POSITIVE] OK, thank you so much for spelling that out for me. All right, let me see if I can find them by the name.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. I do believe I have the patient pulled up now. Let me see if I have any active policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and is this going to, what kind of claim is this going to be? Is it going to be medical or dental?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Medical clinic.
[AGENT][NEUTRAL] Medical?
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For the data service C 21 [PII].
[CUSTOMER][NEUTRAL] For the charges of 80, yeah, 816.
[AGENT][NEUTRAL] And the charge amount please?
[AGENT][NEUTRAL] 816 even.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and then what is the name of the facility that you're calling from Kevin?
[CUSTOMER][NEUTRAL] Physician specialty and anesthesia.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back sir.
[CUSTOMER][NEUTRAL] Yes, so I can. You are on hold.
[AGENT][NEGATIVE] Oh shit.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. Thank you for holding for me. So looking on this claim, the claim number is 3529961.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, one second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, just a second. One moment. Yeah, just a second. Yes, go ahead. I'm ready now, claim number.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] 352-9961.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because the policy terminated on [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] [PII]. So, the date of service is uh [PII], right? OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I got it. So, no active policy, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll put the date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And uh for the same date of service, could you also check for uh another bill amount?
[AGENT][NEUTRAL] OK, what is the billed amount?
[CUSTOMER][NEUTRAL] Like uh $768 even.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And and the red button.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 10 minutes.
[CUSTOMER][NEUTRAL] 180 minutes around 1 hour.
[CUSTOMER][NEUTRAL] one
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I do show the claim was submitted. The claim number is 3529955, and the claim was denied for the same reason.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, can I get the claim number one more time?
[AGENT][NEUTRAL] Yes, it's 352-995-5.
[CUSTOMER][NEUTRAL] I wanna do that.
[CUSTOMER][NEUTRAL] Isn't
[CUSTOMER][NEUTRAL] Thank you. So, uh, so the member needs to update the policy or, uh, we need to find an active insurance for the member, right?
[CUSTOMER][NEUTRAL] We need to contact the number. OK. And uh can I, can I get your name?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, the policy is no longer active.
[AGENT][NEUTRAL] Yes, uh, my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful and uh all the friends.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you. Thank you for your patience and information. Have a happy weekend. Bye for now.
[AGENT][POSITIVE] Thank you, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Um, no further questions, thank you.
[AGENT][POSITIVE] OK thank you you have a good weekend and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Yeah.