AccountId: 011433970860
ContactId: fb49dd32-7a3b-4035-ab4d-8b4eee67fca2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337019 ms
Total Talk Time (AGENT): 159632 ms
Total Talk Time (CUSTOMER): 122180 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/fb49dd32-7a3b-4035-ab4d-8b4eee67fca2_20250113T19:37_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from Optum Medical Care. Calling to know the claim status. Could you please help me out?
[AGENT][NEUTRAL] Yes, I can definitely help verifying claim status and and we can assist you with that today, but before we proceed, is it possible to get a callback number in the event that we get disconnected please?
[CUSTOMER][NEUTRAL] Yes, sure, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And do you happen to have the policy number which you're inquiring about?
[CUSTOMER][NEUTRAL] Yes, we have the policy number. It's 024.
[CUSTOMER][NEUTRAL] 05510.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that, [PII]. And can you also verify the patient's full name and date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When you
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth? [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you for that. And are you also able to verify their mailing address, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, the patient's mailing address? Sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Yes, it's got it. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] City, [PII].
[CUSTOMER][NEUTRAL] ZIP code [PII].
[AGENT][NEUTRAL] Thank you for that and you stated you were calling to verify claim status. What's the date of service on the claim you're inquiring about?
[CUSTOMER][POSITIVE] And thank you for calling.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of service [PII].
[AGENT][NEUTRAL] OK, the patient's policy is no longer active as of [PII]. Wait a minute.
[AGENT][NEUTRAL] She has another policy.
[AGENT][NEUTRAL] OK, let me give you an updated policy number with a more current effective date.
[CUSTOMER][NEUTRAL] You watch.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] So good
[CUSTOMER][NEGATIVE] OK. Yes, actually, here, we got the denial.
[CUSTOMER][NEUTRAL] From the American Public Life Insurance that it was denied as uh claim or service covered by another payer.
[AGENT][NEUTRAL] OK, um, I'm limited to see the denial code, but I do see that she has another policy. What I'm gonna have to do is let you speak to someone in the claims department. They can help you with those details, but I wanted to give you the correct policy number because the one that you have is an active. She does have an active policy though.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. OK. Can you please give me the updated policy number?
[AGENT][NEUTRAL] Yes, sir. Not a problem, Mr. [PII]. That policy number is 253.
[CUSTOMER][NEUTRAL] Yes sir
[CUSTOMER][NEUTRAL] 253.
[AGENT][NEUTRAL] 81
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] OK. It's 253-810-1.
[AGENT][NEUTRAL] Yes, sir, and that policy is active and paid current.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And if you'll bear with me one moment, I'll let you speak with someone in our claims department regarding that denial and we can see what else we can do to help you with that, OK?
[CUSTOMER][NEUTRAL] OK. What?
[CUSTOMER][POSITIVE] OK, yeah, thank you so much.
[AGENT][NEUTRAL] All right, I'm gonna place you on a brief hold while I transfer you. Is there anything else I can help you with before I transfer you?
[CUSTOMER][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, I'm good. Please transfer the call.
[AGENT][POSITIVE] All right, and I'll make sure I give them all the information so you won't have to repeat yourself, Mr. [PII]. Thank you for calling APL and you have a wonderful day and hold please.
[CUSTOMER][POSITIVE] Thank you for calling
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][NEUTRAL] Sing.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] This is easy.
[AGENT][NEUTRAL] Hey, [PII], I've got a provider on the back line that's checking the claim status on an insurance policy. He's stating he got a denial code.
[CUSTOMER][NEUTRAL] OK. And what's that policy number?
[AGENT][NEUTRAL] It's 253-810-1 [PII].
[AGENT][NEUTRAL] Um, he actually gave me her old policy number. I'm not sure if that's the one that he got the denial on, but it's 240.
[AGENT][NEUTRAL] 5510.
[AGENT][POSITIVE] And he does have the correct updated policy number now as well.
[CUSTOMER][NEUTRAL] OK, we'll figure it out. You can send him over.
[AGENT][NEUTRAL] All right, and his name is [PII] and do you want the callback number?
[CUSTOMER][NEUTRAL] Yeah, what's the callback number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] And everything's been verified.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you [PII] here he goes, have a good day.
[CUSTOMER][POSITIVE] You too. Thanks.