AccountId: 011433970860
ContactId: 9c14ad15-b829-4ca5-8cc0-dec954caf1b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451119 ms
Total Talk Time (AGENT): 183192 ms
Total Talk Time (CUSTOMER): 163911 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/9c14ad15-b829-4ca5-8cc0-dec954caf1b1_20250114T13:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] And my last name is [PII] [PII]. I'm calling for a provider's office to check on.
[AGENT][POSITIVE] I'm so sorry. I
[AGENT][NEUTRAL] I'm so sorry, but we do not have a connection that's good. I can't understand what you're saying. I'm so sorry.
[CUSTOMER][NEUTRAL] Oh, it's OK, no problem. Now, are you able to hear me better?
[AGENT][POSITIVE] Uh, that is better, yes.
[CUSTOMER][NEUTRAL] Oh yeah, this is [PII]. I'm calling for a provider's office to check on additional information about the client that has been denied.
[CUSTOMER][NEUTRAL] Please note this call will be monitored and recorded for the quality and training purposes. [PII], right? Your name?
[AGENT][NEUTRAL] That is correct. And [PII], you said that you're needing additional information on a claim that you already have the status on that was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, yeah. Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is the callback number for you please?
[CUSTOMER][NEUTRAL] Yeah, the callback number [PII], and it's a direct line or exchange.
[AGENT][NEUTRAL] OK, we missed a number there. What is the phone number again, please?
[CUSTOMER][NEUTRAL] Oh, sure. It is [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII] it's a direct line no exchange.
[AGENT][NEUTRAL] Thank you. OK, thank you. And what is the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] ID is 1457.
[CUSTOMER][NEUTRAL] 298 M. like Mike L like Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] My first name is uh [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, um, what is the date of service and total bill amount for her place?
[AGENT][NEUTRAL] Or for him.
[CUSTOMER][NEUTRAL] Uh, so the date of services are [PII], and the total amount I'll give you one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The total bill amount is $4530 even.
[AGENT][NEUTRAL] Thank you and the claim number?
[CUSTOMER][NEUTRAL] OK, one second, please. Let me open the UV.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the total bill amount again is how much?
[CUSTOMER][NEUTRAL] OK. The total amount is 4000, 1 2nd.
[CUSTOMER][NEUTRAL] It is $4530 even.
[AGENT][NEUTRAL] OK, let me look at just a couple of things, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Do you need a claim number now?
[AGENT][NEUTRAL] OK, so I don't, well, you're saying, but I don't show that the we don't have any claims for that bill amount for this data service.
[CUSTOMER][NEUTRAL] OK, let me double check the buildup.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Do you see 40 $4500 even?
[AGENT][NEUTRAL] Yes, ma'am, I do. Uh huh.
[CUSTOMER][POSITIVE] Oh yeah, that is the claim. I'm so sorry for the incorrectable amount.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] We only have a claim on file for that bill amount.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] That is the point.
[AGENT][NEUTRAL] And what is the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the claim number you're referring to?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 354 3
[CUSTOMER][NEUTRAL] 415.
[AGENT][NEUTRAL] OK, so that claim was denied as a duplicate because this claim has been received more than once.
[CUSTOMER][NEUTRAL] OK. And may I know the original claim, uh, status now, please?
[AGENT][NEUTRAL] OK, so the claim was received on [PII] and it was processed and denied on [PII], I'm sorry, my screen switched. Hold on one second, [PII]. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] My claim number is 353-213-0.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Uh, this claim was denied. The reason for the denial on here states that services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy termed.
[AGENT][NEUTRAL] 61 of 2019.
[CUSTOMER][NEUTRAL] 61 of [PII], OK.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. And there is no other coverage beyond that point with APL.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, and in this case, can I get the effective date for the plan which ended on [PII]?
[AGENT][NEUTRAL] It was effective from [PII].
[AGENT][NEUTRAL] To its term date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Got it. Thank you very much. And uh can I have the call reference number, please?
[AGENT][NEUTRAL] Yes ma'am, you will actually use my name in today's date and also [PII], do you have our portal website so that you can print this EOB if you need a copy of the one that I just gave you the claim number for?
[CUSTOMER][NEUTRAL] Uh, let me double check the UV that we received previously. One moment, that you received or no one moment.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, we do already have another UB and the claim number that you provided now. Uh, which one ended in 130?
[AGENT][NEUTRAL] OK, but for future reference, yes, ma'am, you can also check claim status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] We already have
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I got it.
[AGENT][NEUTRAL] OK. Well, can I help you with anything else, [PII]?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Nothing crazy and uh anyways, thank you so much for your assistance and patience with me have a wonderful rest of your day.
[AGENT][POSITIVE] Absolutely. Yeah, you're very welcome and I hope you have a very nice day too, [PII].
[AGENT][POSITIVE] And thank you for calling. Uh-huh. You're welcome.
[CUSTOMER][POSITIVE] Bye for now. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm