AccountId: 011433970860
ContactId: bd66e4dc-cc3e-45cb-9451-f8feeb284943
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386739 ms
Total Talk Time (AGENT): 123033 ms
Total Talk Time (CUSTOMER): 95177 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/bd66e4dc-cc3e-45cb-9451-f8feeb284943_20250403T15:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Sata Medical Foundation to non a claim status.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with a claim status, and I'm sorry, how do you spell your name?
[CUSTOMER][NEUTRAL] It is [PII] and [PII]. Last name is [PII].
[AGENT][NEUTRAL] OK, and um, and you say you're calling from where? from my location?
[CUSTOMER][NEUTRAL] Sata Medical Foundation.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It is 02450890.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the data services, uh, [PII], and the total charges $2,361 even.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK. [PII] of [PII] for um 2,361.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. Let's see what we have. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] another.
[AGENT][NEUTRAL] Um, do you know the, what's the procedure codes? Can I get the procedure codes?
[CUSTOMER][NEUTRAL] It is 5,233,274,420.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, let me look at this one really quick one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 0823.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm waiting on the EB. One moment.
[AGENT][NEUTRAL] OK, looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is that our record indicate that the premium for the date of service was not received. Therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Oh, it got denied what? Uh, could you please help me with that one again?
[AGENT][NEUTRAL] Our records indicate
[CUSTOMER][NEUTRAL] OK, that
[AGENT][NEGATIVE] That the premium for the date of service was not received.
[AGENT][NEUTRAL] Therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Could you please help me uh members effective date?
[AGENT][NEUTRAL] Yes, um, let me get that for you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That is effective [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Could you please be online for 1 to 2 minutes? Sure.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK. Uh, could you please confirm whether the member has outage on Medicare?
[AGENT][NEUTRAL] I'm sorry, can I confirm what?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Could you please confirm that member has a Medicare policy?
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] We're not gonna know that. We don't, we don't have access to any other insurance for this member.
[CUSTOMER][NEUTRAL] OK, could you please help me when did you receive the claim and process the claim? When did you receive it?
[AGENT][NEUTRAL] Yes, I can give you that information. OK, so the claim was received, let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] All right. Let me see [PII].
[AGENT][NEUTRAL] Of [PII], process [PII].
[CUSTOMER][NEUTRAL] OK, could you please spell your name for document purpose?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] And the reference number would be?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you for the information. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling