AccountId: 011433970860
ContactId: f04fd48b-c3d6-4cd8-b88b-99548f9ed3d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274260 ms
Total Talk Time (AGENT): 123690 ms
Total Talk Time (CUSTOMER): 86380 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/f04fd48b-c3d6-4cd8-b88b-99548f9ed3d4_20241231T15:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, and I was, I'm calling, my name is [PII]. I'm calling from emergency physicians.
[CUSTOMER][NEUTRAL] Uh, association, uh, I am calling regarding a claim that was submitted over to you. I just wanted to get claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Sure. My um my phone number would be area code, area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 384 [PII].
[AGENT][POSITIVE] Thank you for that and the member's policy number.
[CUSTOMER][NEUTRAL] I have a case number and a policy. Policy number I have is 1231774.
[AGENT][NEUTRAL] OK, hold on one moment. And may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, name is [PII]. Date of birth [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Uh yes. Uh 3 dates.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Injury date was [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Total bill was.
[CUSTOMER][NEUTRAL] 900 no, $1,039 with 0 cents.
[AGENT][NEUTRAL] 0 cents. OK, this one, hold on one second.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So it looks like we received this twice. Um, so the first time we received, well, first, hold on one second, let me double check this one. Yeah, emergency physicians, OK. The first time we received it was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 3373309.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], it was denied requesting an explanation of benefits from primary insurance.
[AGENT][NEGATIVE] Which I don't know why it was denied with that, because the policy hasn't been active since [PII], but then we received it again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII], um, that was claim number 3, hold on one second.
[AGENT][NEUTRAL] 339-862-2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And then on [PII], it was denied because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The policy was active from [PII], and they haven't had an active policy with APL since [PII].
[CUSTOMER][NEUTRAL] OK, so you didn't patient didn't even have a policy at that time.
[AGENT][NEUTRAL] Not with APL.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm, OK, I see that. Mm.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Is there a reference number? I'll have to send the claim to the patient.
[AGENT][NEUTRAL] Um, so there's no reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much have a have a wonderful day.
[AGENT][NEUTRAL] You're welcome. And again, all the information provided was a verification of benefits, not a guarantee of payment. And [PII], was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that would be it thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and [PII].
[CUSTOMER][NEUTRAL] Same to you. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.