AccountId: 011433970860
ContactId: fe1acbdc-7739-4dea-be4f-db06e6bf99c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519590 ms
Total Talk Time (AGENT): 165720 ms
Total Talk Time (CUSTOMER): 190360 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/fe1acbdc-7739-4dea-be4f-db06e6bf99c9_20250106T17:45_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from the provider's office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you, Miss, Miss [PII]?
[CUSTOMER][POSITIVE] I'm doing great, thank you. Can I have your name for my documentation purposes, please?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Mhm. That is correct.
[CUSTOMER][NEUTRAL] OK so.
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, that's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII] and direct line no extension.
[AGENT][NEUTRAL] All right, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, that's gonna be 02464472.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $250 even.
[AGENT][NEUTRAL] OK. So [PII] for 250. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me, and this is for dental or this is for medical?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Medica.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me check on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, OK, so it looks like it's been processed twice. Um, let me get the last denial, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] Can I have the claim received it?
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the most recent one was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was received on [PII] and it was processed on [PII], right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied stating that our records indicate that the premium for the date of service was not received. Therefore benefits are not payable. The policy is terminated.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK, uh, can you repeat the denier reason again? Records 40.
[AGENT][NEGATIVE] Records indicate that the premium for the date of service was not received.
[AGENT][NEUTRAL] Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] Right, it's indicate that the premium for the date of service, which is [PII], did not receive. Therefore, the benefits won't be payable, right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK. Can I have the policy effective date?
[AGENT][NEUTRAL] Oh, sure, yes.
[CUSTOMER][POSITIVE] That's that's great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Effective date is on [PII].
[CUSTOMER][NEUTRAL] Effective from [PII] and got terminated on [PII].
[AGENT][NEUTRAL] [PII]. Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the payer ID?
[AGENT][NEUTRAL] The payer ID is um let me see which one is this 11 moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This one is 64556.
[CUSTOMER][NEUTRAL] It's 645-556, right? OK, so can I put you on a brief hold?
[AGENT][POSITIVE] Mhm. Correct, yes.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Take your time.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Thank you so much for staying on the line, sir. So do you, uh, can you verify if the patient has any other active insurance on file?
[AGENT][NEUTRAL] Sure. Yeah.
[AGENT][NEGATIVE] None with us.
[CUSTOMER][NEUTRAL] OK, none of fit with you, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, do you wanna see that if any letters were sent out to the patient?
[AGENT][NEUTRAL] We did send out the same explanation of benefit, a copy of the explanation of benefits to the member. Yes.
[CUSTOMER][NEUTRAL] OK. You'll be listening to the patient. OK.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I feel better than I do.
[CUSTOMER][POSITIVE] Thank you so much for staying online. Uh, can I have the date when the EOB was sent to the patient? Do you have that information?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's the same day that the one for you went out the same, um, we send a copy every time we send one to the provider, so it's the same date, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. Can you provide me with the claim number, sir?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, the claim number is 351-6116.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 351-611-6 and can you provide me with the call reference number?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, it's gonna be [PII] introduce it [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK, so thank you so much for assisting me on this call. Have a great day and a happy New Year.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Have a good day bye.
[CUSTOMER][NEUTRAL] OK bye.