AccountId: 011433970860
ContactId: c479601e-5d8d-4c99-b0ea-fa5229a599ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530020 ms
Total Talk Time (AGENT): 187566 ms
Total Talk Time (CUSTOMER): 112946 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/c479601e-5d8d-4c99-b0ea-fa5229a599ba_20250327T19:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] from the doctor's office to check on a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with clients, um, Mr. [PII], and you said it's from the doctor's office. Uh, what is the name of the doctor's office?
[CUSTOMER][NEUTRAL] It's Penny Royal Healthcare Services.
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, callback number is.
[CUSTOMER][NEUTRAL] Where it is, OK, it's [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02288795.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So, patient name is uh [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So date of service is [PII] and the amount for the claim is $190.94.
[AGENT][NEUTRAL] OK, you said [PII], correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, and for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let me pull this ELB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm waiting on the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we processed the claim [PII] and the claim was denied. The reason for this denial is, let's see, our records indicate that the premium for the date of service was not received, therefore benefits are not payable. Um, the policy is terminated. I can give you a termination date.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, so the policy was effective from [PII], and there's no other policies with us available.
[CUSTOMER][NEUTRAL] know that
[CUSTOMER][NEUTRAL] Just a moment and you said could you repeat the the [PII] date?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] The deny of the claim or the lapse day?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Which one is the last day, the denied day of the claim, OK. The claim was denied on [PII].
[CUSTOMER][NEUTRAL] The denied date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I just want to know some few information here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, mm, is this, so does the policy subject to uh like anything like grace period, so it's like a
[AGENT][NEUTRAL] Well, it's been terminated since [PII]. This claim is for [PII].
[AGENT][NEUTRAL] So it's been a while since it's been terminated.
[CUSTOMER][NEUTRAL] OK, so what would be the grace period?
[CUSTOMER][NEUTRAL] Do you have that information like the.
[AGENT][NEUTRAL] The grace period is usually 90 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So we can go ahead and uh build the patient, right?
[AGENT][NEGATIVE] It's up to the provider's discretion and right now the policy is terminated.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Alright thank you can I get the claim number?
[AGENT][NEUTRAL] Sure. The claim number is, let's see, 347-0668.
[CUSTOMER][NEUTRAL] Anything before 347?
[AGENT][NEUTRAL] No, it's 347-066-8.
[CUSTOMER][POSITIVE] Thank you and [PII] actually I have uh uh 2 more 2 more data services for the same patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I think it would be the same situation, but I need the claim number. Let me provide you the date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me know when you're ready.
[AGENT][POSITIVE] I'm ready. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, that's 411-2024.
[CUSTOMER][NEUTRAL] Hey, uh, my name is [PII].
[AGENT][NEUTRAL] 22.
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] The total charge on the claim is 242 49.
[AGENT][NEUTRAL] OK, yes. All right. So this claim is the same denial. The, the, and the claim number on this one is 350.
[AGENT][NEUTRAL] 2929.
[CUSTOMER][NEUTRAL] All right. Do you have the denied date in front of you?
[AGENT][NEUTRAL] Um, let me pull that up. I'll have to pull the client for that one, OK? One moment. Let me see [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Alright, let me move to the last year of service. Let me know when you're ready.
[AGENT][NEUTRAL] OK, bear with me let me get out of this.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] That's um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What month is it?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK. How much is it for?
[CUSTOMER][NEUTRAL] It's for $190.94. 190.94.
[AGENT][NEUTRAL] OK, thank you. I'm not.
[AGENT][NEUTRAL] So it's the same denial reason.
[AGENT][NEUTRAL] Um, this one was processed on [PII].
[AGENT][NEUTRAL] Let me give you the claim number. It's 3483763.
[CUSTOMER][NEUTRAL] And um you said your name is [PII], right?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] Alright and thank you so much for help and assistance.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, I'm done thank you so much once again.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Mm bye-bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Bye.