AccountId: 011433970860
ContactId: f41ac1af-faf6-4971-99f9-7d2cea64e397
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431260 ms
Total Talk Time (AGENT): 147909 ms
Total Talk Time (CUSTOMER): 173840 ms
Interruptions: 5
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/f41ac1af-faf6-4971-99f9-7d2cea64e397_20250617T14:58_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] This is [PII] calling from provider office to check claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim, claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. The contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One claim only.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02141823 M as in Mike L as in Lima 7.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, my first name is uh spelled as [PII]. And the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is uh yes, and the date of birth is [PII].
[AGENT][POSITIVE] Thank you
[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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] I still get to you.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the uh bill amount is 10,000.
[CUSTOMER][NEUTRAL] Dollars.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, sir, I'm calling from it's Kendal Anesthesia Associate and the provider name is uh A as in Alpha, L as in Lima, E as in Echo, S as in Sam, S as in Sam, I as in India, O as in Oscar. And the last name is um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Assuming they tried to process it under.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] What? 246-585-8?
[AGENT][NEUTRAL] That had to be what happened because we're.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] So then how did he get that?
[AGENT][NEUTRAL] How did he get that?
[AGENT][NEUTRAL] What? Wait a minute, 214-1823.
[AGENT][NEUTRAL] Alright, 3.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, wait a minute. Maybe she wasn't active then.
[AGENT][NEUTRAL] Right, that's what happened. She didn't become effective until, OK, I got it.
[AGENT][NEUTRAL] OK. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, I have to check on an effective date for the patient, um, but I'm showing that we received the claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1732.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the charges submitted are not payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Services were rendered prior to the policy's effective date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So her her part of the policy became effective on [PII].
[AGENT][NEUTRAL] So it wasn't active on the data service.
[CUSTOMER][NEUTRAL] OK, not active, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But upon checking, the dinner is um lack of information.
[AGENT][NEGATIVE] So, the claim was submitted multiple times. The initial claim was denied because the policy wasn't active on the data service. Um, we then received it again and it was denied as a duplicate.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Of the original, which is because the policy wasn't active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. Yeah. May I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day. Bye bye.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah