AccountId: 011433970860
ContactId: ed44927f-9d59-4b74-ac02-5818febac229
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311040 ms
Total Talk Time (AGENT): 140478 ms
Total Talk Time (CUSTOMER): 62029 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/ed44927f-9d59-4b74-ac02-5818febac229_20250121T20:49_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from office. I'm searching for claim service.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] I'm looking for a bill claim clarification.
[AGENT][NEUTRAL] I'm sorry, what type of verification?
[CUSTOMER][NEUTRAL] The clarification.
[AGENT][NEUTRAL] You're needing a denial clarification, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][POSITIVE] Yes, I can help you. And what is your name again?
[CUSTOMER][NEUTRAL] My first name is [PII]. Last name it is [PII].
[AGENT][NEUTRAL] [PII] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII]. Extension is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check for the denial status?
[CUSTOMER][NEUTRAL] Only one time.
[AGENT][NEUTRAL] A clarification.
[AGENT][NEUTRAL] OK, and what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 02407342.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And [PII], any information that I provide today will be a verification of benefits and not a guarantee of payment. You will use my name that I gave you along with today's date if you need a call reference number and if you need a copy of the explanation of benefits for the claim, you may obtain that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] First name, first name is [PII]. The last name is [PII], and date of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount that you're calling in regards to, [PII]?
[CUSTOMER][NEUTRAL] The service [PII] and the build amount.
[CUSTOMER][NEUTRAL] $31 even.
[AGENT][NEUTRAL] And you said data services [PII]?
[CUSTOMER][NEUTRAL] 531, 531 and [PII].
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sorry for apologies, uh that service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this claim has been received more than once. The most recently received claim was denied as a duplicate of previously submitted expenses. Do you need the original claim denial?
[CUSTOMER][NEUTRAL] Yes, can I get the original claim status?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The original claim was received on 5-22-2024, processed on [PII].
[AGENT][NEUTRAL] The claim number is 3459819.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] And the reason for the denial states.
[AGENT][NEUTRAL] Our records indicate that premium for this service date was not received, therefore benefits are not payable.
[AGENT][NEUTRAL] This policy has an effective date of [PII], I'm sorry, [PII] and a term date of [PII].
[CUSTOMER][NEUTRAL] Can I know any other pay active?
[AGENT][NEGATIVE] There is not.
[AGENT][NEGATIVE] Not with our company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get call reference number of this claim?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, that's all for today. Thank you for assisting me. Have a nice day. Bye for now.
[AGENT][POSITIVE] OK. Well, you're very welcome. Yes, bye-bye and thank you again for calling APL. I hope you have a nice rest of your day as well.