AccountId: 011433970860
ContactId: ba9e2feb-94ec-4ccf-9207-02344eb77bf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330820 ms
Total Talk Time (AGENT): 122226 ms
Total Talk Time (CUSTOMER): 94540 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/ba9e2feb-94ec-4ccf-9207-02344eb77bf8_20250605T15:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey now, my name is [PII]. I'm calling from provider office and I'm looking for claim status. Can you please sir?
[AGENT][NEUTRAL] OK, well, I can help you with the claim. You said claim status and benefits?
[CUSTOMER][POSITIVE] Yes, please start it.
[AGENT][NEUTRAL] OK. I can help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number [PII], the direct line.
[AGENT][NEUTRAL] Thank you. And may I have your um the member's policy number?
[CUSTOMER][NEUTRAL] OK. It is 949-976.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name, it is.
[CUSTOMER][NEUTRAL] Uh [PII]. Last name is [PII] and the birthday is [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] [PII]. total bill, it is 100, OK, it is $17,790 even.
[AGENT][NEGATIVE] Can you repeat the figure again? The phone's breaking up.
[CUSTOMER][NEUTRAL] $17,790.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] OK. Name of the provider is Saint Francis Barlet.
[AGENT][NEUTRAL] OK, and I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3,551,540.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy was active from [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK, [PII] working.
[AGENT][NEUTRAL] I'm giving you the effective date and the termination date of this policy.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII] and termination, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and when this claim was denied?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The claim was denied on [PII].
[CUSTOMER][NEUTRAL] So you are saying that uh this uh like uh plan has been terminated yourself?
[AGENT][NEUTRAL] Yes, your date of service is [PII].
[AGENT][NEUTRAL] The policy terminated in [PII], 2 years before, so it was not active on your date of service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So this is the like secondary insurance and family is already processed and that uh like uh forwarded this amount to secondary, that is you. So what we can do further now, like if the plan is not active, like we have to bill the patient or something.
[AGENT][NEUTRAL] We do not determine patient responsibility because we're not a major medical insurance company. So it will be whatever your your policies are on remaining or outstanding balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is not the patient responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility at APL, sir.
[CUSTOMER][NEUTRAL] Yes. Uh, can you please give me your policy number and your name?
[AGENT][NEUTRAL] Sure, my name is [PII] [PII]. There's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, no, I think that's all from my side and thank you so much to me.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.