AccountId: 011433970860
ContactId: d993c680-1064-469a-b234-fc93765321cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289660 ms
Total Talk Time (AGENT): 121837 ms
Total Talk Time (CUSTOMER): 90278 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/d993c680-1064-469a-b234-fc93765321cb_20250115T14:08_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for the provider's office. And this call is made to get additional information on a claim that has been denied. Please be informed that this call will be recorded and monitored for quality and training purposes.
[AGENT][NEUTRAL] OK. And did you say that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell your name for me, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And also, what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And you said that you're needing additional information on a claim that has been denied, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your um patient's policy number?
[CUSTOMER][NEUTRAL] 1106323 M. Mike Lima 5.
[AGENT][NEUTRAL] You said 1106323? That was the first part of the number, is that correct?
[CUSTOMER][NEUTRAL] Yes, 1106323.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] OK, and any information, OK, that I provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is
[CUSTOMER][NEUTRAL] [PII]. Last name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, now thank you. Now this is an old policy number that termed back in [PII]. What is your data service and total bill amount that you're calling about?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Number 7, 2024 for $30 even.
[AGENT][NEUTRAL] OK, so you have an old policy number um actually let me look, we haven't.
[AGENT][NEUTRAL] She doesn't have a policy that's active for that data service. Let me look on the other policy that she had to see if we received the claim.
[AGENT][NEUTRAL] So just one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is, uh, you said your data service is $11724 for $30 was that correct?
[CUSTOMER][NEUTRAL] 11 7 2024 and the bill amount is, one moment.
[CUSTOMER][NEUTRAL] It is for $190 even.
[AGENT][NEUTRAL] OK, where did the 30 come from?
[AGENT][NEUTRAL] So the billed amount is 190.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] primary has paid $160.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so how can I, you already, do you already have this claim number?
[CUSTOMER][NEUTRAL] Yeah, actually, the claim was rejected in our end stating
[CUSTOMER][NEUTRAL] The services were rendered after coverage was terminated.
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] And the claim number is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number 3542271.
[AGENT][POSITIVE] Yes, sir, that is correct. So how can I help you with that?
[CUSTOMER][NEUTRAL] Can I have the policy of [PII]?
[AGENT][NEUTRAL] Effective date was [PII] and term date [PII].
[AGENT][NEUTRAL] And there is no other active policy for this data service.
[CUSTOMER][NEUTRAL] OK, that means the patient is not active for the data service and that is not active coverage for the data service, right?
[AGENT][NEUTRAL] That's what that means.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] My name and today's date and if you need a copy of that explanation of benefits, you may print that author by going to our portal at [PII].
[CUSTOMER][POSITIVE] Thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] All right, you too, and thank you again for calling APL. Have a nice day.