AccountId: 011433970860
ContactId: c2a61bc8-24df-4274-8e28-a27fe70025e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548719 ms
Total Talk Time (AGENT): 108259 ms
Total Talk Time (CUSTOMER): 117269 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/c2a61bc8-24df-4274-8e28-a27fe70025e0_20250522T14:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider office regarding claim clarification. And could you spell your name, please?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, [PII], this is [PII]. It's [PII].
[AGENT][NEUTRAL] OK [PII], thank you very much for calling APL um and you said you were calling about claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] The patient
[CUSTOMER][NEUTRAL] Yeah, the member ID is going to be.
[CUSTOMER][NEUTRAL] 189483 and the patient's first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you, ma'am. Let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, can you repeat the policy number for me one more time?
[CUSTOMER][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] And the policy number is going to be?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, it's 1896483.
[AGENT][POSITIVE] OK, thank you. I appreciate that.
[AGENT][NEUTRAL] OK, and it's for [PII].
[AGENT][NEUTRAL] I've got her pulled up. May I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, sure. And the date of service is going to be, it's [PII]. And the total charge amount for this member is going to be, it's $1,201 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] There's no primary insurance is there.
[CUSTOMER][NEGATIVE] It's totally $1201 even.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] The Memorial Hospital for Cancer and all late.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII] while I look up this claim and I'll be right back, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, [PII]. So I do have the claim information for you. The claim number is 3385061.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim has been denied because the services were rendered after the termination date of the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, could you repeat it one more time? The service.
[AGENT][NEUTRAL] The services were rendered.
[CUSTOMER][NEUTRAL] was rendered after the?
[AGENT][NEUTRAL] Termination date of the policy.
[CUSTOMER][NEUTRAL] OK. Uh, main, yeah, OK.
[AGENT][NEUTRAL] Meaning the, the policy was terminated.
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] Yeah, OK. When was it was terminated?
[AGENT][NEUTRAL] The effective date of the policy is [PII] and the policy ended on [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. And could you send the UV through our fax number?
[AGENT][NEUTRAL] Yes, what is your fax?
[CUSTOMER][NEUTRAL] Yeah, sure. And the fax number is going to be just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sorry for that. Just a moment, please.
[AGENT][POSITIVE] Yes, take your time.
[CUSTOMER][NEUTRAL] Yeah, and uh uh and the, sorry, and the fax number is going to be.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get this EOB faxed over to you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. I just want to know the call reference number.
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. Thank you so much for assisting me, [PII]. Have a great day.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII] and thanks for calling APL. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Yeah,