AccountId: 011433970860
ContactId: c5d60aa7-5e66-4361-bd1f-00e363f5d706
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1187160 ms
Total Talk Time (AGENT): 225888 ms
Total Talk Time (CUSTOMER): 234954 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/c5d60aa7-5e66-4361-bd1f-00e363f5d706_20250108T14:42_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the provider office regarding the claim status. Could you please help me in the status of the claim?
[AGENT][NEUTRAL] Oh sure, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] Yeah, first name is [PII], last name is [PII].
[CUSTOMER][NEUTRAL] Could you please help me with the details?
[AGENT][NEUTRAL] Sure, I can assist you with claim status. May I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, one second. Just a moment.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] made a good
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, Meridia, Meridia Memorial Hospital.
[AGENT][NEUTRAL] OK. OK, and may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Just a moment, I'll provide you that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy number is 02540055.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] May I have uh the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The name of the data, name of the patient. Just a moment. I'll provide you that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, missinga is the first name and the last name is [PII] Kind.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, perfect. And what's the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service [PII] and the bill amount is $50.82.
[AGENT][NEUTRAL] All right. And that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and for future you can check claim status online through our website at [PII].
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, but in this case there is a denial is on and the procedure code is 936272 CPT code.
[AGENT][NEUTRAL] I'm sorry, um, yeah, bear with me, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we process the claim [PII].
[AGENT][NEGATIVE] And it was denied because our records indicate that the premium for the date of service was not received, therefore benefits are not payable. Policies terminated.
[CUSTOMER][NEUTRAL] OK, when was the claim received date?
[AGENT][NEUTRAL] OK, so it was received [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The [PII] and uh what is the ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. OK, OK, reason for the reason for the denied?
[AGENT][NEUTRAL] Our records indicate that the premium for the date of service was not received, therefore benefits that are not payable, policies is not terminated.
[CUSTOMER][NEUTRAL] Should I mention
[CUSTOMER][NEUTRAL] Oh, premium was can be slowly getting past premium is.
[AGENT][NEGATIVE] Premium for the date of service was not received.
[AGENT][NEUTRAL] Therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Bets are not payable.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, but when was, uh, you're saying that uh
[CUSTOMER][NEUTRAL] What is the budget date for this?
[AGENT][NEUTRAL] OK, the effective date of the policy, let's see.
[AGENT][NEUTRAL] was [PII] and it terminated [PII].
[CUSTOMER][NEGATIVE] OK, but there is no reason, but the reason for dinner is premium is not, uh, premium is not received on benefit, not payable in the repeat for the sentence for me once again. The reason for the dinner is premium is not.
[AGENT][NEGATIVE] Premium is not received, therefore benefits are not payable policy terminated. That, that is the denial reason.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Uh, premium is not premium is not received. Therefore, the benefits are not payable for this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But effective date is [PII] and the termination is level 10-224.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Um, ma'am, do they have any other active policy for member?
[AGENT][NEUTRAL] No, we don't have any active policy for this member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Uh, so do I need to get.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] There, there is no active policy for member. There's no active policy member, but it is showing that um.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, we don't have any other policy.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But the CPT code is $93,272,450.82. What is showing that uh the this function of this service is line pending for the review showing that.
[AGENT][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Can you please check it for that?
[AGENT][NEGATIVE] Mr. [PII], it was denied. I just gave you the denial reason. So it was denied, it was closed denied because the policy is terminated. There's no, um, it was not active on that date of service. The policy terminated [PII]. That is the denial of reason.
[AGENT][NEGATIVE] But that will be the only denial reason is because it was terminated. There was no active policy during the time of service, not with us. We don't have any other policies available for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but uh, the, in the description is showing that the disposition of the service line pending for the review. Can you please once check it for you will be for that?
[AGENT][NEUTRAL] That is, that is not our denial. Again, that's not our denial. I, I just repeated our denial. Our denial is the one that I just stated to you that the one that you're giving me is not our denial. That's not what we state in our documents.
[CUSTOMER][NEUTRAL] OK, can you please check the UB ones.
[AGENT][NEUTRAL] I'm looking at it. I'm looking at it right now. I have it in front of me and that the denial is totally different, which is that our records indicate that the premium for the date of service was not received, therefore benefits are not payable. That is the denial on the EOB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, but we have the 93272, the procedure code.
[AGENT][NEGATIVE] I understand, but it was denied. It's not payable.
[CUSTOMER][NEUTRAL] 9327.
[CUSTOMER][NEUTRAL] The bill amount is $50.82. Am I right?
[AGENT][NEUTRAL] I understand. I understand. Yes, $50.82 is not payable. The policy is terminated.
[CUSTOMER][NEUTRAL] OK, OK. OK.
[CUSTOMER][NEUTRAL] OK, could you please help me in the claim number and the call reference?
[AGENT][NEUTRAL] Sure, um, the claim number is 354-0769.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And we don't have reference numbers. You can use my name. We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] All of
[CUSTOMER][NEUTRAL] What's your
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] My name is [PII], that's [PII].
[CUSTOMER][NEUTRAL] OK. Your name is [PII] at to date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] is the last initial. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just
[AGENT][NEUTRAL] Mhm. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a nice.
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a nice day.
[AGENT][NEUTRAL] You as well.
[AGENT][POSITIVE] You as well, Mr. [PII] and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.