AccountId: 011433970860
ContactId: fffb5531-f56c-494d-96e9-89fa5020d7c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280489 ms
Total Talk Time (AGENT): 126761 ms
Total Talk Time (CUSTOMER): 59436 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/fffb5531-f56c-494d-96e9-89fa5020d7c0_20250304T20:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was trying to check on the status of a claim.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 1666266
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, the patient is [PII] [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 bill for the claim?
[CUSTOMER][NEUTRAL] Yes, um, I have two. I have 1125 24 for $290 and 1126 24 for $283.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And will it be the same provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I just located both plans. I'm just waiting for them to come up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for the um total bill of $283 we received the claim on [PII].
[AGENT][NEUTRAL] And that claim number is 353-7951.
[AGENT][NEUTRAL] And the claim was denied. Well, actually,
[AGENT][NEUTRAL] I'll give you the other information too, because they were denied it for the same reason. Um, the other date or the other amount, $290 was received also on [PII]. They were both processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that um claim number is 353-797-6.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] I made a mistake for the date that was received, it was [PII] for the um the one ending in 7976 that we just went over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they were both denied because the services were were rendered following the termination of coverage. So the policy was active. Um, hold on one moment.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] And there were no other active policies with APL after that policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So they scanned in the APL card in November.
[CUSTOMER][NEUTRAL] Um, can you look up his, did you look it up by policy holder just to make sure there were any other policies?
[AGENT][NEUTRAL] Well, yes, so, um, once you get into one policy, you'll be able to access all policies even if they weren't um active.
[AGENT][NEUTRAL] And this is the only policy they've had.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, alright, um, and you said it turned on [PII].
[AGENT][NEUTRAL] Um, yes, let me double check, hold on one moment.
[AGENT][NEUTRAL] Um, yes, it turns on [PII].
[CUSTOMER][POSITIVE] OK, that is all I needed thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.