AccountId: 011433970860
ContactId: ab11399a-0c7b-4773-a5dd-ad5b21a9d13a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304260 ms
Total Talk Time (AGENT): 113420 ms
Total Talk Time (CUSTOMER): 93474 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/ab11399a-0c7b-4773-a5dd-ad5b21a9d13a_20250317T16:01_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Lake Cumberland Regional Hospital, and I'm looking for a claim status.
[AGENT][POSITIVE] OK, sure. I can assist you with my status. How do you spell your name?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Miss [PII].
[CUSTOMER][NEUTRAL] Yes, it's [PII] and extension is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, it is 025.
[CUSTOMER][NEUTRAL] 20305.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Date of service, um [PII]. Total charge is $4,238.81.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and for the future, you can check claim status online through our website at [PII].
[AGENT][NEUTRAL] And see.
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] Secure. A Public.
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And this was for an ER visit.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me pull this EOB one moment, OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It looks like we processed the claim [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that our records indicate that the premium for the date of service was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Um, all right. And what is the denial date and the claim number?
[AGENT][NEUTRAL] In denial date is the same as the process date, which is [PII]. The claim number is 3526088.
[CUSTOMER][NEUTRAL] All right, so the denial reason is member didn't uh uh pay the premium, right?
[AGENT][NEGATIVE] Yes, premium for the date of service was not received. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right. So, uh, we actually, we've already contacted to the member regarding this. Can you please double check if patient update the information now?
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Um, we already processed twice. Uh, the last time that we processed was processed as a duplicate because it it's still the same, same reason for the denial.
[CUSTOMER][NEUTRAL] All right. Um, thank you so much. And can you please confirm the member's policy effective or term date also?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm, sure, let me get that for you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The policy was terminated on [PII].
[CUSTOMER][NEUTRAL] And what was the effective date?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you so much. And could you please spell out your name for me?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Thank you. May I get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you so much. You have a great day. Bye-bye.
[AGENT][POSITIVE] You are well. Thank you for calling APR.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.