AccountId: 011433970860
ContactId: d0411a28-78da-44ce-a819-b507e41cb6e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292239 ms
Total Talk Time (AGENT): 92721 ms
Total Talk Time (CUSTOMER): 96363 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/d0411a28-78da-44ce-a819-b507e41cb6e4_20250327T21:40_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office regarding claims.
[AGENT][NEUTRAL] OK, yeah, I could check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Could you please spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] And then did you have that policy number?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yes, the policy number is 02502300.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that one what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. And the total bill amount for this one is $219422.25.
[AGENT][NEUTRAL] OK, and again I'm sorry, that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so I will tell you that this policy terminated, uh, [PII], but I will still go ahead and check to see if we received this claim.
[CUSTOMER][NEUTRAL] [PII], are you there?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, you have stated that the policy has been terminated on September?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course, right, one moment please. I can still check to see if we received it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] I'm sorry, uh, [PII], what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Riverside Community Hospital.
[AGENT][NEUTRAL] OK, yes, so I did find this claim, um, we did receive it and of course we were unable to pay a benefit as the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. May I know the claim received date?
[AGENT][NEUTRAL] Yes, this claim was received in [PII].
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh so may, could you please explain the generalization so that I can document it?
[AGENT][NEUTRAL] The services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] After the term policy termination, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. Please be online. Let me check with that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, can you able to find if there any other insurance for this uh um member?
[AGENT][NEUTRAL] I did check, uh, they don't have any active policies with us.
[CUSTOMER][NEUTRAL] Uh, no, they don't have any active policies or uh for the whole thing.
[AGENT][NEUTRAL] Not with us they don't have any active policies with APL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah. May I have the claim number?
[AGENT][NEUTRAL] Yes, but it's 353-267-6.
[CUSTOMER][NEUTRAL] OK. May I have the call reference for today?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with then?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh no, thank you so much for your assistance. Have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course the