AccountId: 011433970860
ContactId: 9b0cd74c-52f7-4369-a8b6-312b675287de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588489 ms
Total Talk Time (AGENT): 167788 ms
Total Talk Time (CUSTOMER): 142809 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/9b0cd74c-52f7-4369-a8b6-312b675287de_20250218T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and my last name initial is [PII] calling from provider's office to check on a claim status. Could you spell your name, please, for the documentation purpose?
[AGENT][NEUTRAL] [PII] last initials [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]
[AGENT][NEUTRAL] You're welcome. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] What is the policy number please?
[CUSTOMER][NEUTRAL] Yes, the policy number is D41203335.
[AGENT][NEUTRAL] What is the patient's last name, the last name only?
[CUSTOMER][NEUTRAL] Yes, the patient's last name is [PII].
[AGENT][NEUTRAL] Spell that for me for documentation.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] OK, and what is your first name please?
[CUSTOMER][NEUTRAL] Yes, the first name is [PII].
[AGENT][NEUTRAL] OK, and then [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, yes, that's correct.
[AGENT][NEUTRAL] OK, are you calling for a medical policy or a dental policy?
[CUSTOMER][NEUTRAL] I'm calling for the claim status medical policy.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Verify the member's date of birth.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The member's date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total bill amount is $947 even.
[AGENT][NEUTRAL] OK, that was [PII], total charges $947 even.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And also just a reminder to you, [PII], you can check claim status by visiting our secure portal at [PII] and also there you'll be able to obtain EOBs again that website is [PII]. Excuse me. If you could please also [PII], verify the procedure code or codes bill for the service date please.
[CUSTOMER][NEUTRAL] Uh, yes, uh, I have.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I have 3 denials here for the CVV code [PII] and uh [PII] and [PII].
[AGENT][POSITIVE] Thank you very much one moment please.
[AGENT][NEUTRAL] OK, excuse me, [PII]. I found it here. OK, there it shows that there was a lapse in coverage for that date of service. Therefore, no payment was made on this particular claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know claim receive date?
[AGENT][NEUTRAL] Of course one moment.
[AGENT][NEUTRAL] It shows that the claim was received on.
[AGENT][NEUTRAL] [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, yes, um.
[CUSTOMER][NEUTRAL] May I know why this number is not eligible for the date of service?
[AGENT][NEUTRAL] So we had, I'm sorry, the member had a lapse in coverage for that particular week of service, so therefore no payment was made on this claim.
[AGENT][NEUTRAL] Like you really
[CUSTOMER][NEUTRAL] OK. Uh, for the particular week, the member is inactive, right?
[AGENT][NEUTRAL] There was no eligibility for that particular week.
[CUSTOMER][NEUTRAL] OK. So you're stating that uh the member doesn't have any active policy right now.
[AGENT][NEUTRAL] No, that is not what I stated, um, I figured that there was a lapse in coverage for that particular week of service.
[AGENT][NEGATIVE] The policy with the member still shows active, but for that particular week of service there was not any eligibility received. There was a lapse in coverage.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, just give me a minute. Uh, I'll be back.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] She likes
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hello. Thank you for the wait. Yes, [PII], I'm here. Thank you for the wait. Uh, could you please mention the lapse period uh for the particular, uh, week, uh, that start date and end date.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows the week of [PII].
[CUSTOMER][NEUTRAL] From [PII].
[AGENT][NEUTRAL] The week of [PII].
[CUSTOMER][NEUTRAL] Um, that's the service data. I'm asking about, uh, you said that, uh, this number is not, uh, eligible for, for a particular period, uh, for, for a week, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, I need the two dates, uh, I mean, the starting date and the ending date.
[AGENT][NEUTRAL] One moment please. Let me place you on a brief hold, OK? One moment please, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes. You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The week of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From [PII], right?
[AGENT][NEUTRAL] That is correct. That is the week of the [PII], yes.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Um, thank you, and thank you for the information.
[AGENT][POSITIVE] You're welcome [PII], anything else I can help you with?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that's all, [PII]. Can I get the call reference number?
[AGENT][NEUTRAL] We do not use call reference numbers [PII]. You can use my name and today's date, last initial [PII] like [PII], and we thank you for calling us at APL.
[AGENT][POSITIVE] You have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome thank you for calling APL.