AccountId: 011433970860
ContactId: eb58897f-e45b-408c-a486-353251409f8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270869 ms
Total Talk Time (AGENT): 87359 ms
Total Talk Time (CUSTOMER): 80838 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/eb58897f-e45b-408c-a486-353251409f8f_20250410T19:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for the provider to check on the additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I this [PII].
[AGENT][NEUTRAL] OK, [PII], so you're needing to get additional information, did you say on 2 claims?
[AGENT][NEGATIVE] They were denied
[CUSTOMER][NEUTRAL] One claim only.
[AGENT][NEUTRAL] One claim, OK, yes, I can help you with that, [PII], and what is a good callback number for you please?
[CUSTOMER][POSITIVE] Thank you. The best callback number will be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, thank you and [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The medical policy number starting with
[CUSTOMER][NEUTRAL] 009
[CUSTOMER][NEUTRAL] 67957
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And out of any information provided would be a verification of benefits and not a guarantee of payment. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment, [PII].
[CUSTOMER][NEUTRAL] ESB?
[AGENT][NEUTRAL] What is the data service and total bill amount that you're calling about?
[CUSTOMER][POSITIVE] Thank you. The date of service on.
[CUSTOMER][NEUTRAL] [PII] and this claim is totally built for $195 even.
[AGENT][NEUTRAL] And the claim number you have?
[CUSTOMER][NEGATIVE] Actually, the claim number here I'm concerned.
[CUSTOMER][NEUTRAL] Um, it is 356.
[CUSTOMER][NEUTRAL] 751 2.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK. So, yes, sir, I do have that claim. And how can I help you?
[CUSTOMER][NEUTRAL] Thank you. It's showing like the plan actually turned on this before the date of service. So please provide me the policy effective and termination date.
[AGENT][NEUTRAL] The effective date on this plan was [PII].
[AGENT][NEUTRAL] And 15 term date 10-1-2024.
[CUSTOMER][NEUTRAL] So, here,
[CUSTOMER][NEUTRAL] On [PII], there is no active coverage is, is it correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Thank you. And may I get the call reference number for our conversation, please, [PII]?
[AGENT][NEUTRAL] Yes, the uh reference number would be my name and today's date and then [PII], do you also have our portal website if you needed a copy of this explanation of benefits you could print it.
[AGENT][NEUTRAL] Since you have the claim number.
[CUSTOMER][NEUTRAL] Actually, I do not have access to the portal access now.
[AGENT][NEUTRAL] OK, the website for the portal is [PII] and it is self-registering.
[CUSTOMER][POSITIVE] Thank you so much for your assistance about the past and clarification. And that's it for today. Have a great day.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK. All right, [PII]. Well, you're very welcome and thank you again for calling APL if that's all I can help you with. I hope you have a nice day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.