AccountId: 011433970860
ContactId: b760ef12-8dc3-4427-b5bf-61734adba336
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311529 ms
Total Talk Time (AGENT): 173176 ms
Total Talk Time (CUSTOMER): 82613 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/b760ef12-8dc3-4427-b5bf-61734adba336_20250203T18:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Premier Health Specialist regarding a claim.
[AGENT][NEUTRAL] OK, [PII], are you needing to check claim status?
[CUSTOMER][NEUTRAL] Well, we received processing of the claim, but I have a question.
[AGENT][NEUTRAL] Oh, you already have
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct.
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 123 7160
[AGENT][NEUTRAL] OK, so give me a couple of moments to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount please, [PII]?
[CUSTOMER][NEUTRAL] [PII] for $190.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, so, yes, ma'am, I do see that um we did receive that claim.
[AGENT][NEUTRAL] And the claim, do you already have the claim number, [PII]?
[CUSTOMER][NEUTRAL] Um, I do, yes.
[AGENT][NEUTRAL] OK. And so how can I help you with that?
[CUSTOMER][NEUTRAL] I'm just wondering why nothing was paid on the balance after Medicare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] This is not a supplement or this is a, was a supplemental policy to a private cause we're not affiliated with Medicare, but let me look at something.
[CUSTOMER][NEUTRAL] What are you?
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I'm sorry, can you repeat the last thing you said? Because the phone cut out for a second and I only heard like the last couple words.
[AGENT][NEUTRAL] 00, my goodness. OK. So we did receive this claim and yes, it was denied. This is not a supplement to Medicare, but the reason this was denied, give me one moment, I'll read you the remark.
[AGENT][NEUTRAL] This was a supplemental policy that he had to uh private.
[AGENT][NEUTRAL] Major medical insurance?
[AGENT][NEGATIVE] And actually at the time of service, this policy was not active. So it's the denial remark states these services were rendered after coverage was terminated. This policy had termed one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you
[AGENT][NEUTRAL] [PII], uh, I'm sorry, [PII]. Now, if you need a copy of the excellent.
[CUSTOMER][NEUTRAL] [PII]. OK, got you. OK.
[AGENT][NEUTRAL] Mhm. Correct. Um, actually, that's not correct. I'm sorry, I'm giving you the date of service you just gave me, [PII].
[CUSTOMER][NEUTRAL] That's the date of service.
[CUSTOMER][NEUTRAL] Like, wait a minute, what a, what a.
[AGENT][NEUTRAL] You know, she, it's gonna be a really long week at this pace that I'm on today.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] You know, I called and said something to somebody that made no sense today too, so must be the day.
[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] Uh, well, the two dates I'm looking at, they're right next to each other and so, yes. Anyway, so this policy was termed as of [PII], and there is no other coverage with us. Now, if you need a copy of the explanation of benefits, we do have a portal and our website that you can go to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is [PII]. [PII].
[AGENT][NEUTRAL] And with that claim number that I gave you, you should be able to print that.
[CUSTOMER][NEUTRAL] Public.
[AGENT][NEUTRAL] Mhm, secure. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, got you and do you give reference numbers for calls?
[AGENT][NEUTRAL] Uh, you would use my name along with today's date.
[CUSTOMER][POSITIVE] All right. Thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] Well, you are certainly, yes, ma'am, you're very welcome. And can I help you with anything else, [PII]?
[CUSTOMER][POSITIVE] That's it. That answers my question.
[AGENT][POSITIVE] Alright, well I hope you have a wonderful afternoon and thank you again for calling APL.
[CUSTOMER][POSITIVE] You enjoy your afternoon as well. Thank you bye bye.
[AGENT][POSITIVE] Thank you. OK, bye-bye.