AccountId: 011433970860
ContactId: c6a126ae-9bec-49fa-aff3-3c13dd670fda
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300820 ms
Total Talk Time (AGENT): 128846 ms
Total Talk Time (CUSTOMER): 137439 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/c6a126ae-9bec-49fa-aff3-3c13dd670fda_20250130T14:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, hello [PII]. My name is [PII]. Last name initial is [PII], and I am calling from Laboratory Corporation of America. Um, this call will be recorded for training and quality purposes. [PII], I am calling regarding a claim that you submitted for one of our mutual patients. Can you please help me?
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh sure, uh, the number I, oh, I'm sorry, my callback number is [PII]. For the policy number, it will be D for Delta 43730559.
[AGENT][NEUTRAL] Thank you. And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Oh no, ma'am.
[AGENT][NEUTRAL] OK, um, um, what is the member, do you have the full social for the member?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] That the policy number, that's for 90 degree benefits, so we can't use that here, but I'm gonna try and see if I can pull something with the social. Do you also have the claim number, that'll help too.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Uh, upon checking the EOB, it is 353-060-0. Is this correct?
[AGENT][NEUTRAL] Wait, wait, wait, can you, can you repeat that, please slow down?
[CUSTOMER][NEUTRAL] I'm sorry, sorry, I'm sorry, 353-060-0.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I have the policy number here. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this claim was processed under policy number 248.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1731.
[AGENT][NEUTRAL] And let me see what the reason, what happened with it.
[AGENT][NEUTRAL] I'm pulling the claim now hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it looks like the claim was denied um waiting for eligibility from the employer. And what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] Uh, you said, uh, it is denied because you're waiting for eligibility from employer?
[CUSTOMER][NEUTRAL] Am I right?
[AGENT][NEUTRAL] Let me make sure, hold on one moment because it's coming up and I see the code, but there's two that's like that. OK, so it says our records indicate that premium for this date of service was not received, therefore benefits are not payable. So this one is for the premium not being received, my apologies.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, premium not received.
[CUSTOMER][NEUTRAL] OK, noted on this one. So is there a patient responsibility on the claim that you can see?
[AGENT][NEUTRAL] Well, let me see what this is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We haven't applied anything, so there, the whole, the balance is still the same. We don't determine patient responsibility because we're not the major medical, but uh however, you all deal with the outstanding balances, that would be the process.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, noted on that one. Thank you very much, [PII], for the information. Um, OK, and, uh, we can submit a, oh no, we cannot submit a corrected payment since it is about the premium of the patient. So I'll be, yeah, I'll be just asking your last name initial [PII] and a reference number for the call, and I'm good to go. Thank you very much.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You're welcome. Um, so the first initial to my last name is [PII]. There's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK, so that would be [PII] [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] And all the information, I'm sorry.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm sorry, go on.
[AGENT][NEUTRAL] Uh, just for the call, all the information provided was a verification of benefits, not a guarantee of payment. And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, that's all for the moment. You're so, uh, very helpful and uh thank you very much for your time. May you have a great day ahead.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Good bye.