AccountId: 011433970860
ContactId: b4013a30-a888-425c-abd5-74c4bf1aed2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459380 ms
Total Talk Time (AGENT): 159952 ms
Total Talk Time (CUSTOMER): 137317 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/b4013a30-a888-425c-abd5-74c4bf1aed2b_20250203T22:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling to check on a claim.
[AGENT][POSITIVE] OK, and I'll be more than happy to help you with your claim. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and [PII], how many claims do you have in total today?
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] 01697851.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII] Date of birth of the patient is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $74,520 even.
[AGENT][NEUTRAL] Thank you for that. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure, it's HCAFL Mersey Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the um claim was received on [PII].
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 3044.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] So this policy was active from [PII].
[CUSTOMER][NEUTRAL] Is that the policy was active from [PII]?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And do you find any other active uh policy for the member?
[AGENT][NEUTRAL] No, there's no other active policy, and that was the only policy with APL.
[CUSTOMER][POSITIVE] All right. Thank you so much for this information.
[CUSTOMER][NEUTRAL] And do you find the same policy ID which is inactive is 01697851?
[AGENT][NEUTRAL] You're welcome, hold on.
[AGENT][NEUTRAL] Yes, that's the policy number you provided.
[CUSTOMER][POSITIVE] All right, thank you. And one quick moment, I'll move to the next number.
[CUSTOMER][NEUTRAL] Information
[CUSTOMER][NEUTRAL] And for reference, can I use your name in today's date?
[AGENT][NEUTRAL] Yes, that would be um the reference for the entire call.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] And I'm ready for the next member's policy number whenever you are.
[CUSTOMER][NEUTRAL] Yes, one quick moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much for patiently holding. The next policy ID is 02022379 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Manual chair, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the data service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the claims charge amount will be $38,209 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] So I don't, we don't have any claims on file for that data service, the range or the date of [PII] by itself.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Could you please help me with your mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you. And could you please help me with the member's policy effective on term date?
[AGENT][NEUTRAL] Um, the policy is still active. Um, let me see how long it's been active. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Policy has been active since [PII].
[CUSTOMER][POSITIVE] Thank you so much. And could you please help me with the member's group number and group name?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So the group number is 23143.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Group name is Nova Southeastern University.
[CUSTOMER][NEUTRAL] Uh, could you please repeat the group name?
[AGENT][NEUTRAL] Nova Southeastern University.
[CUSTOMER][NEUTRAL] Thank you. And could you please help me with the number plan type?
[AGENT][NEUTRAL] This is a meddling supplemental gap insurance.
[CUSTOMER][POSITIVE] Thank you so much. And for my documentation, could you also please help me with your fax number and the pay ID please?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] Attention APL claims department.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And our payer ID is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you. Thank you so much for all this information and for reference, can I use your name in today's date?
[AGENT][NEUTRAL] Yes, that will be the reference for the entire call.
[CUSTOMER][POSITIVE] All right. And I do feel some issues and I'm not able to move to the next one. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you