AccountId: 011433970860
ContactId: b77e4811-3416-428c-9cd8-0bbec5692df1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323160 ms
Total Talk Time (AGENT): 137884 ms
Total Talk Time (CUSTOMER): 51810 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/b77e4811-3416-428c-9cd8-0bbec5692df1_20250414T14:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes I was trying to check on the claim.
[AGENT][NEUTRAL] OK. Are you calling from a provider's office or are you the insured?
[CUSTOMER][NEUTRAL] Uh, provider.
[AGENT][NEUTRAL] OK, and you're needing claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][POSITIVE] Thank you and [PII], what is call back number for you?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] I have D42032214.
[AGENT][NEUTRAL] OK, thank you, but now, [PII], that is not an APL policy number, that is a 90 degree benefit number. Uh, some of these numbers have dual coverage with APL and 90 degree benefits. Were you trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I don't think so. I'm actually not sure. I have another ID as well. Can I, so I'm not really sure which is the right one.
[AGENT][NEUTRAL] OK. All right. It should say policy or policy certificate number.
[CUSTOMER][NEUTRAL] I have 02580380.
[CUSTOMER][NEUTRAL] Is there a number?
[AGENT][NEUTRAL] OK, give me that 11 more time. That would be the one I need. 0258.
[CUSTOMER][NEUTRAL] 0380.
[AGENT][NEUTRAL] OK, thank you. So give me one moment, [PII] to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one second, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the data first off any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] bill amount is $5,0065.00.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, uh, the received date.
[AGENT][NEUTRAL] The received date is [PII].
[AGENT][NEUTRAL] 25. And it was processed and denied a seat on [PII].
[AGENT][NEUTRAL] The claim number is 3566621.
[AGENT][NEUTRAL] And the denial remark on this claim states the charges submitted are not payable because servers, excuse me, services rendered.
[AGENT][NEUTRAL] Prior to policy's effective date.
[AGENT][NEUTRAL] This policy did not go into effect with APL until [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] That makes sense then. OK can I just get a call reference number?
[AGENT][POSITIVE] Yeah, yes ma'am, you're gonna use my name along with today's date and then [PII] we.
[AGENT][NEUTRAL] We also have a portal in which you should be able to check.
[AGENT][NEUTRAL] For us or print out the EOB if you need that by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK, and I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And again, my name and today's date would be your call reference number, yes ma'am.
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][POSITIVE] All right, thank you.