AccountId: 011433970860
ContactId: bd7a5b6a-3420-4d42-8cc4-abfc30d0287a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274440 ms
Total Talk Time (AGENT): 80369 ms
Total Talk Time (CUSTOMER): 113120 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/bd7a5b6a-3420-4d42-8cc4-abfc30d0287a_20250224T15:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling IPA. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] [PII], hi, my name is [PII], and I'm calling to try to follow up on a patient's claims. Um, we had sent some in back last year and I was reviewing the ELBs and it was stating on there that your records were showing that the premium of the service was not received and so the benefits weren't payable.
[CUSTOMER][NEUTRAL] And then I had to know if it was being paid through Cobra to please call. Can you tell me, can you look back at that and tell me if the patient ever, if they ever did have COR or if these are even um covered benefits of what would be their plan because I did look at the card and it said it was a limited benefit plan.
[AGENT][NEUTRAL] OK. Do you have a phone number and in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Mhm, sure it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, [PII]. And do you have a policy number?
[CUSTOMER][NEUTRAL] I do, um, that is 023-084-448.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you just had a question about the claims that was filed as not being covered.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Due to the lapse.
[CUSTOMER][NEUTRAL] Yeah, I mean that's what our ELB had said, but I'm just trying to figure out if.
[CUSTOMER][NEUTRAL] Even if she had had it um.
[CUSTOMER][NEUTRAL] If they cover doctor office injections, I know sometimes they don't cover things like that, so.
[AGENT][NEUTRAL] OK, I can look that up for you, just a moment.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] OK. And what day the service was that for?
[CUSTOMER][NEUTRAL] OK, um, there's, uh, two different days of service. One was [PII].
[CUSTOMER][NEUTRAL] And that was um.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] For $384.
[CUSTOMER][NEUTRAL] And 40 cents.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEGATIVE] Yeah, we never did receive the premiums for that week. This group must pay weekly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, and then was she.
[AGENT][NEGATIVE] But it canceled 64 of 23.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So she didn't even have it then, is that what you're saying?
[AGENT][NEGATIVE] No. Right. She did not.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, alright, I will get that directed.
[AGENT][NEUTRAL] Now, she does have a new policy.
[AGENT][NEUTRAL] But it didn't start to I think 2125. Hold on just a second.
[AGENT][NEUTRAL] Yeah, she, her other policy, her newest policy doesn't start from till [PII]. So during that coverage between 6423 to [PII], she had no coverage.
[CUSTOMER][NEUTRAL] What, what was it? 6 of 23?
[AGENT][NEUTRAL] 64 of 23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To 23 or 22 she her coverage start on 23.
[AGENT][NEUTRAL] 2325, a new policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, no coverage. All right, thank you and may I have a call reference number if there is one?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK, all right, [PII] thank you you have a good afternoon.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye bye.