AccountId: 011433970860
ContactId: c39ad5c6-47c7-4e12-8caf-8965b637f1bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226639 ms
Total Talk Time (AGENT): 65829 ms
Total Talk Time (CUSTOMER): 121903 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/c39ad5c6-47c7-4e12-8caf-8965b637f1bd_20250624T15:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling India. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], my name is [PII]. I'm calling from the American Arthritis and Rheumatology Associate regarding a claim for one of our patients that got denied due to the number of the policy, and I wanted to call to see if they can provide me with the correct one since I am looking at the patient's insurance card and I truly don't know which number to put there as the policy number.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you um with claim status. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and the number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And what policy number are you showing?
[CUSTOMER][NEUTRAL] Well, the policy number that I'm showing that it got denied on the EOB is 02080717.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] But I have
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that that is the correct policy number for her. It's just that under this policy, um, I'm showing the effective date was [PII] and it expired on [PII] and I'm not showing any active policies in the system.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So it expired [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] All right, so it has nothing to do with the member's policy number. It's just a term. No, no services at time of um service, no medical benefits.
[AGENT][NEUTRAL] And what's the date of service on the claim?
[CUSTOMER][NEGATIVE] It's data service June, no, I take that back, that would be [PII], so it should have been covered.
[AGENT][NEUTRAL] Yeah, I'll see if it's on file. One moment.
[CUSTOMER][NEUTRAL] Mhm I have the EOB in front of me.
[AGENT][NEUTRAL] OK. And do you have the claim number?
[CUSTOMER][NEUTRAL] I do, it's 3608733.
[AGENT][NEGATIVE] Yes, ma'am. I'm showing that that claim denied um because office visits are not covered under the policy. Yeah, been denied for the date. It denied because the service is not covered.
[CUSTOMER][NEUTRAL] So this is noncovered? OK, even though now it's been expired. OK, all right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So it's not covered under the patient's plan.
[AGENT][POSITIVE] That's correct, yes, ma'am.
[CUSTOMER][POSITIVE] OK. All right. Very well. Thank you so much, Ms. [PII]. And can, lastly, I have a call reference number for a call, please?
[AGENT][NEUTRAL] I'm sure you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, [PII], so it's [PII], the first name.
[AGENT][NEUTRAL] Yes, ma'am, and [PII] is my last initial. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, with today's date. Perfect. All right. Thank you so much for your help. You have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL bye.
[CUSTOMER][POSITIVE] Thank you alright bye bye.