AccountId: 011433970860
ContactId: c452fa1b-50d0-45de-be5c-6e361803fffc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259798 ms
Total Talk Time (AGENT): 103515 ms
Total Talk Time (CUSTOMER): 85865 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/c452fa1b-50d0-45de-be5c-6e361803fffc_20250203T19:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, my name is [PII]. I'm calling from Pa's office to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes. Uh, the policy number is 202184704 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 1
[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] That's [PII]. and the date of birth 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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Uh, it's [PII] with a billed amount of $4,0065 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Holy Cross Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 6204.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] The policy was active from [PII].
[CUSTOMER][NEUTRAL] However the member was not active for the date of service, uh, so the claim is not, right? Uh.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yeah, that's right.
[CUSTOMER][NEUTRAL] OK. Uh, did the member update his information after this termination date?
[AGENT][NEUTRAL] Did the member update their call information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Like did they update their phone number, like their contact information?
[CUSTOMER][NEUTRAL] Uh, no contact information as the policy was termed on [PII]. Uh, did member ever try to contact to update a new policy that was effective for the date of service?
[AGENT][NEUTRAL] Oh, no, no, no, there were no other active policies after this one.
[CUSTOMER][NEUTRAL] OK, thank you. Thank you, [PII]. Can I have a caller reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Thank you. I needed one more help from you. And could you please fax the explanation of benefits to the fax number?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's 248
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] 2452. Attention to my name, [PII]. Last name initial, [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] Yes, that's absolutely right.
[AGENT][NEUTRAL] Alright, well I'll go ahead and fax this over to you now, [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, no. How many, uh, how many hours it takes to receive any OB?
[AGENT][POSITIVE] Uh, we usually say to give it at least an hour through fax. So if you haven't received it by end of day today, you can definitely give us a call back. We'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] OK. Thank you, [PII], for assisting me and have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Thank you, you also, [PII]. Thanks for calling APO. Bye bye.