AccountId: 011433970860
ContactId: e82b8d0b-be50-4eae-a3bb-f81f05b3bb07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1281420 ms
Total Talk Time (AGENT): 363987 ms
Total Talk Time (CUSTOMER): 698422 ms
Interruptions: 22
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/e82b8d0b-be50-4eae-a3bb-f81f05b3bb07_20250407T19:57_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] Yeah, hi, [PII]. My name is [PII]. That's spelled like [PII]. OK, checking on the claim status. Could you please help?
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that's [PII] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, that's going to be one moment here.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That was 024. Are you ready?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] That's 02448835.
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII], and date of birth is [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that's [PII] of 2024 and bill amount is $1,539 saving.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That's K Coweta Emergency Group LLC OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3431263.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEGATIVE] Because premium for this data service was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So, uh, when the patient was stopped the premium?
[AGENT][NEUTRAL] Um, well, the policy actually is not active. Um, it hasn't been active since [PII].
[CUSTOMER][NEUTRAL] So that policy is not active from the [PII], right?
[AGENT][NEUTRAL] Right, so it wasn't active on the data service either.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, uh, may I know the effective date also?
[AGENT][NEUTRAL] It is effective from [PII].
[CUSTOMER][NEUTRAL] So just confirm once, that's [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So is that member was not act one data service or member was stopped just paying premium on [PII]?
[AGENT][NEGATIVE] Both the policy lapsed on [PII] for non-payment and this claim came in because the premium was not received, so it's all of it.
[CUSTOMER][NEUTRAL] The IN number?
[CUSTOMER][NEUTRAL] So there are both two dinners, right? First one is, uh, premium was not paid, and second one is member not at one date of service, right?
[AGENT][NEUTRAL] No, there is one denial for this claim. That denial is that the premium for the data service was not received, but now that we're on the call, speaking of it more, uh, you also have the termination date to know that the policy was not active on the data service, but that's not a denial reason for the claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Got it. No problem. And yeah, may I know your name? Can you please spell your name?
[AGENT][NEUTRAL] Sure, my name is [PII], [PII] [PII] name is [PII].
[CUSTOMER][NEUTRAL] OK, got it. And uh may I know the conference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK, got it. And I do have some more clients with me. Could you please help me to those accounts?
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, if you don't mind, how many claims you can assist any single call?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How many times you can assist in a single call because I do have almost 10 times with you. So that's the reason.
[AGENT][NEUTRAL] Almost 10 claims.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hold on one moment. Let me note this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the next member's policy number?
[CUSTOMER][NEUTRAL] That's going to be 02444074.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and last name is [PII], and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have that date of service for the member?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's going to be [PII].
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And bill amount is 1400 and that's 1487 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm showing this claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 348.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9011.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation, I'm sorry.
[AGENT][NEUTRAL] The claim was denied because the premium was not received, um, so there are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so, uh, may I know the claim date one second? Cla received date, ma'am.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Um, hold on one moment, let me go back to that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] [PII] and then on [PII] stating that premium is not payable. Mhm. OK. So once the, uh, once the patient starts paying premium, then only you can start the processing, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Um, it doesn't well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Let me tell you.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] This policy is no longer active as of [PII].
[AGENT][NEUTRAL] So there most likely will not be a premium made for the payment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So policies, uh, policy was also termed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But our date of service is [PII] only, right? So the member was active.
[AGENT][NEUTRAL] Right, but you ask if they make the payment, will the claim then be paid and my answer is the policy is is no longer active, so I'm not sure that they'll make a payment on the lapsed policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. And uh when was the patient stopped paying, paying the premium?
[AGENT][NEUTRAL] Uh, we don't give all that information to the provider. The, the policy is no longer active and on your data service, they hadn't made a premium payment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sorry, can you please repeat that one?
[AGENT][NEUTRAL] Yes, we don't provide all of the insured's premium payment information to the provider.
[AGENT][NEGATIVE] For your claim, the premium had not been received and as of today, the policy is no longer active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. Uh, no problem. And uh, shall we move to the next one?
[AGENT][NEUTRAL] Um, hold on one moment. Let me note this policy.
[CUSTOMER][NEUTRAL] 87.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] There.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] So next member ID is going to be one moment here. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So that was 02545268.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Did you got it, ma'am?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, I'm here. Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you. Can you hear me now?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and the data service and the total bills?
[CUSTOMER][NEUTRAL] That was going to be in [PII] and bill amount is $1,487 even and I do have a specific question on this one.
[AGENT][NEUTRAL] OK, and what's your question?
[CUSTOMER][NEUTRAL] Yeah, upon checking, we got some denial letter here stating this claim was denied a maximum benefit maximum for the state of service has been met, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So, uh, the full amount is special responsibility, or do you have any discount?
[AGENT][NEUTRAL] So there is no provider discount and we don't determine patient responsibility. Um, whatever your policies are for outstanding or remaining balances would be applied to this.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, yeah, so the claim was denied for the maximum benefits are being met, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the claim ratio date and denial date?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Her claim was received on [PII] and it was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the claim number is 352-7339, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, got it. And yup, shall we move to the next one?
[AGENT][NEUTRAL] Um, hold on one moment, I have to note each policy.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] I mean you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. So just confirm, uh, just give me clar clarity here. Will you handle the member ID which is starting with D as in David?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so you can help me with only member ID which is starting with 02, right?
[AGENT][NEUTRAL] Right, if they have a member ID, they most, they, they could have a policy here with us, but that D number is for 90 degree benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. What, what about the member ID starting with the A? Will you handle that one?
[AGENT][NEUTRAL] With an A like apple.
[CUSTOMER][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] I, I mean, I don't know, we have old policy number. You can give me the policy number and I can try it. I can't go just off of, it could be an old policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, one second here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second, I'm searching for that member ID. So it's going to be A as in Alpha.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 634-021-110
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, I'll try, but that doesn't look like one, but I'll try. Hold on one second.
[AGENT][NEUTRAL] What's the member's um first and last name?
[CUSTOMER][NEUTRAL] Uh, first name is [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, can you go back to the last name? Can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] Yes, that's [PII]
[AGENT][NEUTRAL] [PII], oh, OK, hold on one moment. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This may be it. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said the date of birth was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, now this is a different member. Um, so for that one, no, this is a different member. It has a different date of birth.
[CUSTOMER][NEUTRAL] OK. So I do have a social security number. So do you want the correct date of birth for the number?
[AGENT][NEUTRAL] What's, you said the corrected date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, but I don't have a, I do have only one date of birth which is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the member's social?
[CUSTOMER][NEUTRAL] That's going to be
[CUSTOMER][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so also with that social, I'm not showing any policies.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So is that member not related to you?
[AGENT][NEUTRAL] What's the member's first?
[AGENT][NEUTRAL] You said [PII], right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, this, this, this member um doesn't have a policy with APL.
[CUSTOMER][NEUTRAL] So that means that uh my not belongs to you, right?
[AGENT][NEUTRAL] From the information provided, no, we do not have a member that matches that information.
[CUSTOMER][NEUTRAL] OK, so that means mama not mama not found for you, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. And uh, shall we move to the next one?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm. So, so next member ID is going to be, are you ready?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] That's going to be 02454209.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And my first name is going to be, that's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] D of service is 220 2024 and total bill amount is $2,194 even. And I do have a specific question on this one as well.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] OK, and what questions did you have?
[CUSTOMER][NEUTRAL] And this one also same as the previous one which we discussed, uh, this one dinner for the benefit maximum or this date of service has been met, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the, is there any product discount?
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] So for any of the claims we go through, there is no provider discount and we do not determine patient responsibility at APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. So, uh, may I know the claim date and denial date?
[AGENT][NEUTRAL] Yes, I received it on [PII].
[AGENT][NEUTRAL] Did you need the claim number?
[CUSTOMER][NEUTRAL] They do.
[CUSTOMER][NEUTRAL] Uh, I do have that one just confirm once. That's 3443065, right?
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and may I know the claim denial date? Yeah.
[AGENT][NEUTRAL] And then on April
[AGENT][NEUTRAL] On [PII], the claim was denied.
[CUSTOMER][POSITIVE] OK, got it. And that's it, man. Thank you. Thanks for assisting me. Have a great day. Bye-bye.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] 1570.