AccountId: 011433970860
ContactId: 072d0862-44de-419e-a439-cffd17b89dd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371529 ms
Total Talk Time (AGENT): 167344 ms
Total Talk Time (CUSTOMER): 95903 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/072d0862-44de-419e-a439-cffd17b89dd1_20250402T19:12_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] Yes please, I am calling to status a medical claim, please.
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII], and the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] It is 02123554.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Alright, thank you, it would be my pleasure to assist you with that claim status for [PII]. What is the data service?
[CUSTOMER][NEUTRAL] 224 25.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $625.46.
[AGENT][NEUTRAL] I'm checking on that. And what is the facility name?
[CUSTOMER][NEUTRAL] Um, Jana Gill MVPC.
[AGENT][POSITIVE] Alright, I'm checking on that claim for you, thank you, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm checking.
[AGENT][NEUTRAL] Now it looks like we did receive that claim from the provider.
[AGENT][NEUTRAL] On [PII] and it was processed on [PII].
[AGENT][NEUTRAL] And it was denied as a duplicate. It looks like the insured submitted the claim as well.
[CUSTOMER][NEUTRAL] OK, yeah, I did. I received the duplicate denial, but I didn't receive any previous claim.
[AGENT][NEUTRAL] Yeah, and it was denied as a duplicate um as the insured submitted the claim, so it was a duplicate claim to that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the insured the claim for the did the insurance pay the insured then?
[CUSTOMER][NEUTRAL] Or how was it originally processed?
[AGENT][NEUTRAL] I'll tell you, what do you mind holding just one moment and let me get you to the claims department and they can go with that. Thank you one moment.
[CUSTOMER][POSITIVE] No, not at all, thank you.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] Great, thanks.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Good afternoon, thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] I have a provider online for claim status on policy number 212.
[CUSTOMER][NEUTRAL] Wait, hold on one second. Let me get to it.
[CUSTOMER][NEUTRAL] OK, you said 212.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3554
[CUSTOMER][NEUTRAL] On the Libby Apes.
[AGENT][NEUTRAL] Yeah, for Libby. Um, the provider claim is 3581844.
[AGENT][NEGATIVE] And they received a duplicate denial.
[AGENT][NEUTRAL] But it's, you know, I.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] For 224 data service.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] This is the 2nd time today that this has come up. I mean, I can't.
[AGENT][NEUTRAL] Share the insured's information on that claim.
[CUSTOMER][NEUTRAL] Right. So it looks like the first thing that
[AGENT][NEUTRAL] But why would it be
[AGENT][NEUTRAL] Deni is a duplicate.
[CUSTOMER][NEGATIVE] It wouldn't be. It was denied incorrectly.
[AGENT][NEUTRAL] And this is the 2nd time I've been.
[CUSTOMER][NEUTRAL] You need to be reprocessed by the examiner.
[AGENT][NEGATIVE] I've, I've dealt with this issue.
[CUSTOMER][NEGATIVE] Yeah, yeah, it has to be reprocessed. It was denied incorrectly to the provider.
[CUSTOMER][NEUTRAL] Because this is the first claim from the provider.
[AGENT][NEUTRAL] Gosh, OK, I just wanted to make sure because I, you know, I can't tell her if it was paid or denied, you know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, yeah, it needs to be reprocessed.
[AGENT][NEUTRAL] OK. I'll put it in the hubs. That's what I needed to know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK dokey.
[AGENT][POSITIVE] All right, thank you. Appreciate it. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Uh-huh. You're welcome.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] [PII], thank you for your patience. This is [PII] again. I spoke with the claims adjuster and that claim was actually um we're gonna send it back for reprocessing for the correct.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, EOB for you, it needs to be reprocessed since that was the original claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I really appreciate your help.
[AGENT][POSITIVE] And we're sending that back and I do apologize. Do you have that claim number just?
[AGENT][NEUTRAL] In case you wanna
[CUSTOMER][NEUTRAL] Um, claim number, yes, claim number is 3581844.
[AGENT][POSITIVE] That's correct. And it'll take, you know, about.
[AGENT][NEUTRAL] 48 hour up to 48 hours to reprocess and then y'all get a an updated EOB.
[CUSTOMER][POSITIVE] OK, I really appreciate it.
[AGENT][POSITIVE] Oh, it's been a pleasure and I appreciate your patience while I did check on that. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, have a good rest of your day.
[AGENT][POSITIVE] I hope you have a wonderful day as well and thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye-bye.