AccountId: 011433970860
ContactId: 9c8e6d37-9837-43bc-8b45-7dbde12f1545
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851919 ms
Total Talk Time (AGENT): 194332 ms
Total Talk Time (CUSTOMER): 124659 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/9c8e6d37-9837-43bc-8b45-7dbde12f1545_20250313T16:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. Uh, for starters, you could spell your name for me?
[AGENT][NEUTRAL] Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much um.
[CUSTOMER][NEUTRAL] I'm calling from HH Heart Center.
[CUSTOMER][NEUTRAL] And um I.
[CUSTOMER][NEUTRAL] I need to check on a claim please or.
[CUSTOMER][NEUTRAL] Eligibility, I don't know which one.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you. Um, first, let me get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 01800.
[CUSTOMER][NEUTRAL] 528.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 1 [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, he does have a new policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] His new policy number is 02.
[AGENT][NEUTRAL] 558233.
[CUSTOMER][NEUTRAL] 02558233
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And the the effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, did he have a policy in effect 627-2024?
[AGENT][NEUTRAL] Yes, ma'am. He did. One moment.
[AGENT][NEUTRAL] And is that the date of service for the claim you're calling about?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Actually, he didn't have a um policy in effect for that date of service. Let's see, that policy um expired [PII] and his coverage did not pick back up until [PII]. So yeah, that's why that claim is denying for benefit max well not benefit maximum, but for the coverage dates.
[CUSTOMER][POSITIVE] Thank you so much. Um, I have two other policies I need to check on if you could.
[AGENT][NEUTRAL] Sure. One moment, please.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] 02439079
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and this policy expired on [PII].
[CUSTOMER][NEUTRAL] And my date of service is [PII], so.
[CUSTOMER][POSITIVE] Don't have to worry about that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If this claim is on file.
[AGENT][NEUTRAL] OK, and what are the bill charges on that claim?
[CUSTOMER][NEUTRAL] $145.
[AGENT][NEUTRAL] OK. Yeah, I see where that one denied. One moment.
[CUSTOMER][NEUTRAL] If you have those denials, could you send those to me?
[AGENT][NEUTRAL] Um, yes, ma'am. I can fax them to you.
[CUSTOMER][POSITIVE] I would appreciate that.
[AGENT][NEUTRAL] OK. And what's your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's attention bunny [PII].
[CUSTOMER][POSITIVE] Yes ma'am thank you so much.
[AGENT][NEUTRAL] Mhm. One moment, please. Let me pull up my fax system.
[AGENT][POSITIVE] OK, thanks for your patience. I finally got my fax system to come up. One moment.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Mhm. No problem.
[AGENT][NEUTRAL] And again, that fax number was [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And what was the date of service on [PII]'s claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, those two are on the way and I'm ready for the next one.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mm, excuse me, the, uh, the last one is 02219871.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And I'm showing the effective date on this policy was [PII] and it expired on [PII].
[AGENT][NEUTRAL] And what is the um date of service and bill charges for his client?
[CUSTOMER][NEUTRAL] $45.
[AGENT][NEUTRAL] And the date of service.
[CUSTOMER][NEUTRAL] I'm sorry, 6:14 24.
[AGENT][NEUTRAL] And was the bill charges $35 even or?
[CUSTOMER][NEUTRAL] 45.
[AGENT][NEUTRAL] Oh, OK, because I'm showing one claim on file. Let's see for the date of service for $35 and then there's another one for $135.
[AGENT][NEUTRAL] But those are the only two claims I'm showing.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] With that data service.
[CUSTOMER][NEUTRAL] The original, I'm sorry, yes, the original was 135, and then after primary paid it was 45.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, here's that claim. It's the [PII] for the date of service because the policy had expired and I just faxed that one also.
[CUSTOMER][POSITIVE] Thank you so much Miss [PII], I appreciate your help.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, do you have a call reference number?
[AGENT][NEUTRAL] Um, for the reference number, you can use my name and today's date.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you.