AccountId: 011433970860
ContactId: d0bc1f07-9e4d-4eec-b4fd-6048d048b7ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309279 ms
Total Talk Time (AGENT): 120451 ms
Total Talk Time (CUSTOMER): 132587 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/d0bc1f07-9e4d-4eec-b4fd-6048d048b7ad_20250220T15:52_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for private office looking for claim status. Could you help me with this?
[AGENT][NEUTRAL] Yeah, I could check mine for you. Uh, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII], spelled like [PII]. It's [PII].
[AGENT][POSITIVE] At least got you OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, please. Uh, callback number is [PII]. This is the direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, I have a member ID number, yes. Uh 9499976.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, insured name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. At least what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, and that bill out please.
[CUSTOMER][NEUTRAL] Just give me a moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, total bid amount is $17,790 even.
[AGENT][NEUTRAL] That was 17,790?
[CUSTOMER][NEUTRAL] Yes. 17,790.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it, thank you. So I will let you know at least that this policy terminated [PII]. I did check to see if they had any others that were more recent and they do not. Did you still want me to check to see if uh we received this claim?
[CUSTOMER][NEUTRAL] Uh, please.
[AGENT][NEUTRAL] OK, of course, one moment.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim and of course we were unable to pay a benefit as the services were rendered after uh coverage was terminated.
[AGENT][NEUTRAL] Did you need that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please. Uh, could you please uh provide me first to the receipt and process it.
[AGENT][NEUTRAL] OK, that is
[AGENT][NEUTRAL] Yes, so this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK. And uh then add for this are not eligible for this service, am I right?
[AGENT][NEGATIVE] Um, it, the coverage was terminated, so, um, the date of service they didn't have coverage, so we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] Uh uh
[CUSTOMER][NEUTRAL] Uh, cover uh coverage is terminated, am I right?
[AGENT][NEUTRAL] Yes, the term date was uh [PII].
[CUSTOMER][NEUTRAL] And what was the effective date?
[AGENT][NEUTRAL] Effective date was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, just give, just give a moment, please.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] sorry, [PII]. Am I right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And uh could you describe the claim number?
[AGENT][NEUTRAL] Yes, that is 3,551,540.
[CUSTOMER][NEUTRAL] 3,551,540, is it?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Thank you. And is it showing any other uh insurance on this claim?
[AGENT][NEUTRAL] No, I did check to see, I did check to see and there's none that I can see. This was the only policy they had with us.
[CUSTOMER][NEUTRAL] OK. And uh can I have your name, please?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], am I right? Thank you. And uh could you just provide me call reference number for this call?
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Sure, 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, please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh, no, ma'am. Thank you. Thank you so much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Same too. bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello. Uh, uh, sorry for, uh, the, uh, late question. And can we, uh, can we be able to pay, uh, uh, if, uh, coverage is not uh active on that day, can we bill to patient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] All right thank you bye bye.
[CUSTOMER][NEUTRAL] Same too. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah