AccountId: 011433970860
ContactId: f48a2443-9d9c-47bb-b3ff-6d3de03ca9a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351130 ms
Total Talk Time (AGENT): 122775 ms
Total Talk Time (CUSTOMER): 111549 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/f48a2443-9d9c-47bb-b3ff-6d3de03ca9a7_20250618T15:34_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] you talk about
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII]. I'm calling from a provider's office and I was calling um to check on a claim status.
[CUSTOMER][NEUTRAL] It's been a while since this patient probably no longer has that insurance, but it's, it was while she was still insured.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, well, I'll be more than happy to help you with the claim status and
[AGENT][NEUTRAL] Excuse me, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's um 281-487.
[CUSTOMER][NEUTRAL] 6453.
[CUSTOMER][NEUTRAL] And let me get that for you hold on here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see here hold on here.
[CUSTOMER][NEUTRAL] Where is my?
[CUSTOMER][NEUTRAL] OK, so the policy number, I have 0253.
[CUSTOMER][NEUTRAL] 6360.
[AGENT][NEUTRAL] And that was 02536360?
[CUSTOMER][NEUTRAL] Yes, 02536360.
[CUSTOMER][NEUTRAL] Now is that the member ID? Would that be the member ID or the policy certificate number, or would that be?
[AGENT][NEUTRAL] OK, wait, hold on one second. Um, so you said 253-6360?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Not here. 02536360.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And yes, that's the policy number. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes ma'am, so the date of service was [PII].
[CUSTOMER][NEUTRAL] Total bill was 357.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 24.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look at the claim?
[CUSTOMER][NEUTRAL] Yes, go ahead, mhm.
[AGENT][NEUTRAL] Actually it's OK, this is all one hold on one moment, it's coming up now.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm showing.
[AGENT][NEUTRAL] So did you need the complete full claim status or you just wanted to know the outcome of the claim?
[CUSTOMER][NEUTRAL] Well, the full claim status, I guess the outcome too because it hasn't been paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 653 1.
[AGENT][NEUTRAL] And on [PII], we processed the, we finished the claim.
[AGENT][NEUTRAL] So the claim is
[AGENT][NEGATIVE] Excuse me, the claim is, it's been denied, but it's on hold. So, um, we're showing that the premium for this date of service was not received. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] So she didn't send her premium and that's what it was?
[AGENT][NEUTRAL] Right, the premium was not received, so we couldn't pay out on any claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so what does this patient have to, so that's her um.
[CUSTOMER][NEUTRAL] The balance that's her balance.
[CUSTOMER][NEUTRAL] It's not right?
[AGENT][NEUTRAL] Um, so we don't, we don't determine patient responsibility because we're not the major medical insurance company. Um, it's the outstanding or remaining balance that would be up to the provider to determine next steps.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will let her know then. Can I get a reference number for this call, [PII]?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, 6.
[CUSTOMER][NEUTRAL] OK, alright, yeah, because I know um it was verified.
[CUSTOMER][NEGATIVE] Um, on the date of service, and it was nothing was mentioned that um no prem premium was you know, had been paid.
[AGENT][NEUTRAL] Well, if you call to check for eligibility.
[CUSTOMER][NEUTRAL] The month.
[AGENT][NEUTRAL] We'll be able to let you know that it's
[CUSTOMER][NEUTRAL] Mhm. They're not gonna, they won't know.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Effective, right. OK. All right, that's fine. I will let her know then. Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was it thank you.
[AGENT][POSITIVE] You're welcome, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too.