AccountId: 011433970860
ContactId: e1d0bc78-fee9-4607-8d23-bce007d45095
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325549 ms
Total Talk Time (AGENT): 134328 ms
Total Talk Time (CUSTOMER): 127684 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/e1d0bc78-fee9-4607-8d23-bce007d45095_20250213T20:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I was wondering if you would be able to tell me, um.
[CUSTOMER][NEUTRAL] Uh, I'm trying to check status of a claim for a patient.
[AGENT][NEUTRAL] OK, I can help you with the claim status, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's um my name is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the uh member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's um 0.
[CUSTOMER][NEUTRAL] 027446
[AGENT][NEUTRAL] 027446
[CUSTOMER][NEUTRAL] Um, it's 02027446.
[AGENT][POSITIVE] OK, it went in and out there, so I missed it. I'm sorry about that. Hold on one moment.
[CUSTOMER][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, that's gonna be [PII]. Total amount billed is $247.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Oh yeah, one second here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] SSM Medical Group.
[AGENT][NEUTRAL] Um, this is actually showing the, the provider's name. I'm sorry.
[CUSTOMER][NEUTRAL] Oh, it's um [PII]
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So I'm showing that we received this claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And the claim number is 355, I'm sorry, 353.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 984 6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy was
[CUSTOMER][NEUTRAL] Oh, she turned, OK.
[AGENT][NEUTRAL] Yeah, this policy was active from [PII].
[CUSTOMER][NEUTRAL] Oh, OK, yeah, that's it's unfortunate your website does not indicate um like when, when I look up, looked up for a claim for her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, it just said no claim on file. It just, it didn't, you know, flag it saying that she wasn't, didn't have coverage anymore.
[AGENT][NEUTRAL] Oh, you're saying when you search under like for your provider for the claim status, it just says no claim on file?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Hm, OK. I didn't, I didn't, um, I'm gonna ask my supervisor if they're aware of that. I don't know if they know that, um.
[AGENT][POSITIVE] Or if there's, if there's something going on. So I'll definitely let them know.
[CUSTOMER][NEGATIVE] Yeah, and I even I even um went back out and just try to check just for eligibility and I didn't see a place where I could do that.
[CUSTOMER][NEUTRAL] It's just, it's just claim status, so I, I don't know maybe I'm.
[AGENT][NEUTRAL] Um, now for
[AGENT][NEUTRAL] For eligibility, um, right now, you can't check eligibility online, but that is coming soon, um, very soon. So, um, be on the lookout for that as well, um, the eligibility and being able to access the claims um easier because we are switching over.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, right.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. Well, that's good.
[AGENT][NEUTRAL] So that is
[CUSTOMER][NEUTRAL] Yeah, yeah, so if you wanna let them know, um, yeah, it doesn't.
[AGENT][NEUTRAL] I sure will.
[CUSTOMER][NEUTRAL] It doesn't flag it anyhow. OK, perfect. Um, [PII], do you have a reference number for today's call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] All right. And is it two Ns or 1?
[AGENT][NEUTRAL] It's 2.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome
[CUSTOMER][NEUTRAL] All right. Well, I will.
[CUSTOMER][POSITIVE] Oh, yeah, I'll go ahead and get that taken care of then. Thank you again and you have a good rest of your day and have a great weekend coming up.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL.
[CUSTOMER][POSITIVE] You bet. Thanks. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.