AccountId: 011433970860
ContactId: e9b9c404-0a9d-473d-aad1-c3f56619e710
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 634840 ms
Total Talk Time (AGENT): 144763 ms
Total Talk Time (CUSTOMER): 118351 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/e9b9c404-0a9d-473d-aad1-c3f56619e710_20250211T19:31_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
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from a provider's office checking on claims. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII], how are you?
[CUSTOMER][POSITIVE] Yeah, doing good, thank you so much.
[AGENT][NEUTRAL] That's good. You're welcome. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] L Lima G Golf Oscar O Oscar.
[CUSTOMER][NEUTRAL] 933.
[CUSTOMER][NEUTRAL] 3234.
[AGENT][NEUTRAL] Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Not sure, just a moment, let me check that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What information do you need in the ID card?
[AGENT][NEUTRAL] Um, the, the policy number that you provided is not an APL policy number on the card, do you see anywhere that says in hospital or outpatient policy er number?
[CUSTOMER][NEUTRAL] OK, let me pull the ID card first, just a moment.
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] I'm unable to find the ID card here.
[AGENT][NEUTRAL] OK, may I have the member's first and last name?
[CUSTOMER][NEUTRAL] Sure. The first name is [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate.
[AGENT][NEUTRAL] Um, does the member have a middle initial?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] And this is for the medical policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] All right, this is the correct, uh, well, this may be the correct policy. All the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure, and that's gonna be [PII].
[CUSTOMER][NEUTRAL] Building amount of.
[CUSTOMER][NEUTRAL] $254 even.
[AGENT][NEUTRAL] I can search on the policy that I just found to see if there is a claim on file, but there has been no policy active with us since [PII].
[CUSTOMER][NEUTRAL] Are you sure about that?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] He has a total of 7 policies.
[AGENT][NEUTRAL] They all terminated between January and April [PII]. There's been no active policy with APL since [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] A 4
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEGATIVE] So no active policies.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So you didn't receive claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For this state of service since there is no policy for this member, correct?
[AGENT][NEUTRAL] If you would like for me to check and see if a claim has been received, I can check for you. I was just letting you know there was no active policy on the data service.
[CUSTOMER][NEUTRAL] If you would like
[CUSTOMER][POSITIVE] OK, so, yeah, that'll be good.
[AGENT][NEUTRAL] Would you like me to see if the claim has been received?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It is a radiology and nuclear medicine, Llc.
[AGENT][NEUTRAL] Um, so there is a claim on file. I'm showing it was received on [PII].
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 9947.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] And let me get the exact reason for you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, our records indicate that no premium was received for the data service. Therefore, no, um, benefits are payable.
[CUSTOMER][NEGATIVE] And no recent update receipt from the member correct as of now.
[AGENT][NEUTRAL] Updates in terms of what type of updates?
[CUSTOMER][NEUTRAL] Update
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] So any premium was made by the patient and.
[CUSTOMER][NEUTRAL] Requested to activate their policy.
[AGENT][NEUTRAL] Oh no, there's been no request. Um, like I said, the policy has been terminated since [PII] because there was no premium received.
[CUSTOMER][NEUTRAL] Something like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if that's the case.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's all the information I need.
[CUSTOMER][NEUTRAL] Mm, just a reference number for today's call.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you will use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][POSITIVE] You're very welcome and thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye for now.
[AGENT][POSITIVE] Thank you. Bye-bye.