AccountId: 011433970860
ContactId: 056a31fe-171d-4442-834d-c19dde774ceb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574700 ms
Total Talk Time (AGENT): 178846 ms
Total Talk Time (CUSTOMER): 160935 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/056a31fe-171d-4442-834d-c19dde774ceb_20250626T13:26_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] Hi [PII]. My name is [PII] and I'm calling from provider's office. I'm looking for claiming status.
[AGENT][NEUTRAL] OK, well I can help you with the claim status can and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2
[AGENT][POSITIVE] Alright, and may I have a good
[CUSTOMER][NEUTRAL] Uh, your name is [PII]. It is
[AGENT][NEUTRAL] My name is [PII] A. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And may I have a good contact number?
[CUSTOMER][NEUTRAL] OK. So I have 2 claims.
[CUSTOMER][NEUTRAL] Yeah, it is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it is uh 02.
[CUSTOMER][NEUTRAL] 003
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] 4 ML.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. Number, first name is [PII] and the last name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] [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] Yeah, it is uh [PII] [PII] and the claim was billed for $354.72.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so we received the claim twice. Did you want the original claim or the second claim?
[CUSTOMER][NEUTRAL] Original
[AGENT][NEUTRAL] OK. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's Pediatric specialist.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] The claim
[AGENT][NEUTRAL] Give me a second. The claim number is 3583992.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is not covered for members plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can you please check if the OK, office visit is not covered, right? Uh, I mean, there is no issue of DS.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] There is no issue with DX code, diagnosis code.
[AGENT][POSITIVE] No, there's no issue with the um diagnosis code. It's the place of service.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And uh uh another claim was denied as duplicate?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] It's OK. Just provide me a call the number for this number.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date.
[CUSTOMER][NEUTRAL] OK, so can you please check for next one?
[AGENT][NEUTRAL] Is it the same member or a different member?
[CUSTOMER][NEUTRAL] It is a different one.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] OK. So, next number ID is 139.
[CUSTOMER][NEUTRAL] 540
[CUSTOMER][NEUTRAL] 6 MLS.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, S as in Sierra.
[AGENT][NEUTRAL] MLS OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, that's it. Mhm.
[AGENT][NEUTRAL] That might be a 7. Can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Yeah. My first name is uh [PII]. It is [PII]. And the last name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] All right, and may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, it is uh [PII] and the claim was billed for $354.72.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so we received this claim 3 times. Are you wanting the original, the second, or the last, or all of them?
[CUSTOMER][NEUTRAL] Uh, so first, you, you can provide me the last one and then if it is denied for duplicate, I mean, uh, last two denied as duplicate, so I will take the.
[AGENT][NEUTRAL] OK, so the first claim and the 2nd claim were denied for the same reason. The 3rd claim is denied as a duplicate.
[CUSTOMER][NEUTRAL] You can provide me the last one first.
[AGENT][NEUTRAL] The last one denied as a duplicate?
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] I'm at so I.
[CUSTOMER][NEUTRAL] What is the duplicate claim number?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 9275.
[AGENT][NEUTRAL] And on [PII], it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, OK. Give me one second.
[CUSTOMER][NEUTRAL] On [PII], which date?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I mean, uh, it was denied on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What date?
[CUSTOMER][NEUTRAL] OK, OK. And then please provide me the original one.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII]?
[AGENT][NEUTRAL] Claim number is 3,558,210.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] This policy was active from
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], and there were no active policies after that.
[CUSTOMER][NEUTRAL] Can you please provide me the effective date again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] So can you please check uh either member has any other insurance active?
[AGENT][NEUTRAL] There's no other insurance with APL after [PII].
[CUSTOMER][POSITIVE] OK. So it's OK. It's OK, no problem. Thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Just, just fax me the UOB uh for this one.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's attention, [PII].
[CUSTOMER][POSITIVE] That's right. Mhm.
[AGENT][POSITIVE] Alright, so I'll go ahead and send the explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, it's OK. No problem. Thank you. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You also, thanks for calling APL.