AccountId: 011433970860
ContactId: b81e6b03-94e4-4eda-b002-5151708b84e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397640 ms
Total Talk Time (AGENT): 143872 ms
Total Talk Time (CUSTOMER): 78214 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/b81e6b03-94e4-4eda-b002-5151708b84e7_20250115T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm checking a claim.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 1449667ML5
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [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 date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, data first data service is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you said the first one you have multiple?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] She has 2 dates services.
[AGENT][NEUTRAL] OK, you can give them both to me if you like at the same time with the total bills.
[CUSTOMER][NEUTRAL] Um, OK, so the first one is 1024 2024 $1,163.
[CUSTOMER][NEUTRAL] And the other one is 10:30.
[CUSTOMER][NEUTRAL] 2024 $722.
[CUSTOMER][NEUTRAL] And I'm actually calling on specific procedure code for both of those data services.
[AGENT][NEUTRAL] OK, what's the code?
[CUSTOMER][NEUTRAL] 97,110.
[AGENT][NEUTRAL] For both?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So this one
[AGENT][NEUTRAL] So 1 $1,163 was the first one and 722 was the second one?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me take a look at this claim. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK, you're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute. She said 102, wait a minute.
[AGENT][NEUTRAL] 4306.
[AGENT][NEUTRAL] OK, I'll do that after this.
[AGENT][NEUTRAL] OK, so it's 2024. Let me see what the total is for this, yeah.
[AGENT][NEUTRAL] OK, that's that, but
[AGENT][NEGATIVE] Oh wait, no, not OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So this is 3542306 and this 722.
[AGENT][NEUTRAL] 3542319.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, um, for both of the claims, both of the codes 97,110, um, the claims were denied because the services were rendered after the coverage had been terminated.
[AGENT][NEUTRAL] So the policy
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The policy was active from [PII], and there were no other active policies after that.
[CUSTOMER][NEUTRAL] One of the
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] With APL.
[CUSTOMER][NEUTRAL] OK, OK, do you show any other insurance on file?
[AGENT][NEUTRAL] Um, I don't. This policy, let me see what it was to. This policy was second to the Maritain Aetna, but I don't have any like information on that policy. It just shows me like the name of the company.
[CUSTOMER][NEUTRAL] Right, OK, so as of right now they don't have a secondary, OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEGATIVE] Deactivate that.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] A reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. So that's [PII] is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you very much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it, thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm bye.