AccountId: 011433970860
ContactId: eac30f8b-66f6-4e2a-ad05-94ad60605ec6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380700 ms
Total Talk Time (AGENT): 60488 ms
Total Talk Time (CUSTOMER): 215695 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/eac30f8b-66f6-4e2a-ad05-94ad60605ec6_20250512T17:16_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm also doing good, thank you for asking. May I know your name? Could you spell out for me?
[AGENT][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] OK. May I know first initial your last name is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. My name is [PII]. This is [PII]. I'm calling to check on the additional information about the claim that has been denied. I'm calling for Emerge, [PII], and please note this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK. Do you have a good uh callback number, [PII], and I can help you with claim status.
[CUSTOMER][NEUTRAL] Sure, I can provide you that. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure, I can provide you that. It's 02230064 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, correct. Yes, date of service for this member as per checking, which is [PII] this year.
[CUSTOMER][NEUTRAL] With the total charge amount of, let me tell you, which is $220.72.
[CUSTOMER][NEUTRAL] As for checking on this claim, you guys are the secondary and primary has left over the copay to you.
[CUSTOMER][NEGATIVE] And uh got denied. We received some explanation of benefit of the correspondence from your side.
[AGENT][NEUTRAL] You said you have the explanation of benefits?
[CUSTOMER][NEUTRAL] Yeah, but I want to know the additional information on this. It was stated that these services were under coverage. Can you help me out with this denial, please, on this procedure.
[AGENT][NEUTRAL] Yes, so the policy terminated coverage on [PII].
[CUSTOMER][NEUTRAL] OK. You mean to say for this procedure code, patient policy or the coverage has been terminated?
[AGENT][NEGATIVE] Yes, our policy has terminated. There's no more coverage under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The policy of the member has been
[CUSTOMER][NEUTRAL] Terminated.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me check from my side. Just one moment. Uh, can you tell me the effective date and the term date of the policy or the start and end date of the policy?
[AGENT][NEUTRAL] Policy was effective [PII], terminated [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]. OK. Let me check. Just one moment only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, not an issue.
[CUSTOMER][NEUTRAL] I can see the provider is participated provider Claus Christie.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, no problem. Thank you so much for the information and for the help, uh. If you want, we can, OK, no problem.
[CUSTOMER][NEUTRAL] If you want, we can submit the corrected claim, right, if we made any correction.
[CUSTOMER][NEUTRAL] If you want to make any correction.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, no problem. I just want to validate the electronic payer ID and the mailing address. Correct me if I'm wrong. Just one moment.
[CUSTOMER][POSITIVE] I'm fetching it faster for you. The mailing address is, uh, may I know like the electronic payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah, we can submit it the one.
[CUSTOMER][NEUTRAL] We can submit it electronically, right?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] No problem. May I know the mailing address also?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's OK. And uh it's [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Would you please send me the correct.
[CUSTOMER][NEUTRAL] OK. May I know the corrected claim filing limit, please?
[AGENT][NEUTRAL] Correct your claim there's no timely filing limit.
[CUSTOMER][NEGATIVE] OK. There is no timely filing for corrected claim.
[CUSTOMER][NEUTRAL] May I know the call reference number for this call, please?
[AGENT][NEUTRAL] It's my name is [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Your name and today's date which is [PII] and today's date. OK, no problem. Thank you so much for helping me out and for the assistance, [PII]. Have a wonderful day ahead. Stay safe and happy Monday. Bye for now.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you for calling.
[AGENT][POSITIVE] Thanks for calling APL you as well bye bye.
[CUSTOMER][NEUTRAL] I do have a