AccountId: 011433970860
ContactId: 9bbd3af6-6661-42f3-90e6-5fc315965be2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455649 ms
Total Talk Time (AGENT): 195678 ms
Total Talk Time (CUSTOMER): 110041 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/9bbd3af6-6661-42f3-90e6-5fc315965be2_20250429T19:22_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from doctor's office to check on the client status. Could you help me with that?
[AGENT][NEUTRAL] OK, then, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, that is correct. And your name is [PII]?
[AGENT][NEUTRAL] OK, you
[AGENT][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] [PII] And [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yes, I see.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] My contact number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the extension of [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] On the member's policy number is 241-6667.
[AGENT][NEUTRAL] Thank you, one moment please while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] OK, so the policy number that you provided for me is not valid for that number, [PII]. Can you verify the policy number again, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have that policy number only. I see.
[AGENT][NEGATIVE] OK, that's not the correct number.
[AGENT][NEUTRAL] You said it was 241-66667?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, that is correct. Are the member policy number starts with an E?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, ma'am. Our policy numbers would not start with an E.
[CUSTOMER][NEUTRAL] Uh, no, we don't have that. Could you share with the member's name and date of birth to get the member's correct information?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I can't search by date of birth. Do you have the full social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, on the social number of [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, say that one more time.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I'm gonna repeat this back the social is [PII].
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the policy that the member had previously had with APL's policy number is 02441719.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy was active.
[AGENT][NEUTRAL] From one, excuse me, the policy has an effective date of [PII].
[AGENT][NEUTRAL] And a termination date of [PII].
[AGENT][NEUTRAL] Uh, the termination date is [PII].
[CUSTOMER][NEUTRAL] OK, so, uh, the member is not active for the data servers?
[AGENT][NEUTRAL] Uh, you have not given me the data service yet. I was just giving you the correct policy information. What is the date of service in total bill amount? That's OK.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][POSITIVE] I'm sorry for that.
[CUSTOMER][NEUTRAL] They are service of [PII] will the month of.
[CUSTOMER][NEUTRAL] $109 even.
[AGENT][NEUTRAL] OK, let me see if we received the claim, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the claim was received and the claim number was 342-0209.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial on the claim, the remark reads as follows our records indicate that premium for this service date was not received, therefore benefits are not payable and yes ma'am, the termination date was prior to the date of service.
[CUSTOMER][NEUTRAL] OK, can I get the client to date?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on [PII] and denied the same day.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefit.
[CUSTOMER][NEUTRAL] [PII] oh.
[AGENT][NEUTRAL] You may print it
[CUSTOMER][NEGATIVE] No, oh, denied ask members not active for the date of services.
[AGENT][NEUTRAL] Yes, ma'am, I read you the remark, uh, the remark.
[AGENT][NEUTRAL] Our records indicate?
[AGENT][POSITIVE] That premium for this state of service.
[AGENT][NEGATIVE] Was not received.
[AGENT][NEUTRAL] Therefore, benefits are not payable.
[AGENT][NEUTRAL] And if you need a copy of the explanation of benefits with that remark on there, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, can I get the uh call reference number?
[AGENT][NEUTRAL] Ah yes ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you for assisting me. Have a wonderful day. Bye.
[AGENT][POSITIVE] Well, I hope you have a wonderful day too, and thank you again, [PII], for calling APL if that is all I can help you with today.
[CUSTOMER][NEUTRAL] Bye bye.