AccountId: 011433970860
ContactId: f1e3280f-23dc-4691-b0a2-8fd2439cacba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519020 ms
Total Talk Time (AGENT): 149522 ms
Total Talk Time (CUSTOMER): 137758 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f1e3280f-23dc-4691-b0a2-8fd2439cacba_20250107T15:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office to check the
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. What is the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh 02450555.
[AGENT][POSITIVE] All right, thank you for that one moment please.
[AGENT][NEUTRAL] May I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, patient's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Uh, date of service, uh, uh, [PII] and total the amount is uh $124 even.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm not showing any claims on file for that data service.
[CUSTOMER][NEUTRAL] Yeah, one moment. Uh, we, I have a claim number with me. Could you check with that?
[AGENT][NEUTRAL] Yeah, absolutely. What is the claim number that you have?
[CUSTOMER][NEUTRAL] Yeah, it's 352-219-6.
[AGENT][NEUTRAL] OK, let me pull this up here.
[AGENT][NEUTRAL] So this claim was for date of service of [PII].
[CUSTOMER][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Did you need the denial? Go ahead.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, I have a, uh, you'll be with me. It does state or the records indicates the premium for the state of services was not received. Therefore benefits are not payable. Uh, do you send any letter, uh, to the patient regarding this?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh yes, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so I'm showing the plan's effective date was [PII].
[AGENT][NEUTRAL] Um, patient doesn't have any other.
[CUSTOMER][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] OK. Can you repeat the, uh, can you please repeat the effective date of the coverage?
[AGENT][NEUTRAL] Uh, the effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The term date was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing any other active coverage with us at this time.
[CUSTOMER][NEUTRAL] OK, but the date of service is [PII], right?
[AGENT][NEUTRAL] That claim that you had given me correct was for [PII].
[CUSTOMER][NEUTRAL] Uh, that is any possibility to reprocess the claim?
[AGENT][NEUTRAL] Let me see here one moment.
[AGENT][NEUTRAL] The claim would have to be reprocessed through benefits and a card. Would you like me to transfer you to them?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need me to check on anything else before I call over to benefits on a card?
[CUSTOMER][NEUTRAL] Uh, no. Uh, may, uh,
[CUSTOMER][NEUTRAL] May I know the
[CUSTOMER][NEUTRAL] A receipt date and the process date for the service.
[AGENT][NEUTRAL] Um, it looks like claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] OK. May I know uh there is any, uh, let us send to the patient regarding this?
[CUSTOMER][NEGATIVE] The premium, premium was not paid.
[AGENT][NEUTRAL] Correct, the denial says records indicate premium was not paid for the state of service. Therefore, no benefits were payable.
[CUSTOMER][NEUTRAL] OK. Uh, do you send any letter to the patient?
[AGENT][POSITIVE] Yes, I would have been um advised to the patient. Yes.
[CUSTOMER][NEUTRAL] Uh, may I know the when you send the last letter to the patient?
[AGENT][NEUTRAL] The date that that was issued to the patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that would have been issued [PII].
[CUSTOMER][NEUTRAL] OK there is any possibility to resend the letter to the patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] There is any possibility to uh send in another letter to the patient.
[AGENT][NEUTRAL] That's, yeah, I mean, it's not something that we're able to reissue. If the insured needs to check on their policy, they can call and verify with us, but we don't have a way to reissue that, unfortunately.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Thank you for your assistance. May I have your name for documentation?
[AGENT][NEUTRAL] My name is [PII], that's [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, can I, can I get the calls for this call?
[AGENT][NEUTRAL] It's going to be my name with my last initial in today's date. My name again is [PII], last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, sir, for your assistance. Have a good day. Take care. Bye-bye.
[AGENT][NEUTRAL] You too. Bye.