AccountId: 011433970860
ContactId: 08e9bfe7-0f01-4826-9ca1-1d4131548495
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263350 ms
Total Talk Time (AGENT): 120188 ms
Total Talk Time (CUSTOMER): 74113 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/08e9bfe7-0f01-4826-9ca1-1d4131548495_20250401T14:45_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], this is [PII]. I'm calling for Warren Clinic, and I'm calling regarding a claim denial.
[AGENT][NEUTRAL] OK, well, I can help you with the claim denial, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, uh, that callback number it is [PII], and that's a direct line.
[CUSTOMER][NEUTRAL] And the policy number is 14572229.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Can you repeat the policy number for me?
[CUSTOMER][NEUTRAL] Yes, it is 14 I'm sorry 1457229.
[AGENT][NEUTRAL] OK hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's um it's for [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 um date of service or the claim number for the claim?
[CUSTOMER][NEUTRAL] I have the claim number. It is 356-097-3.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Data service [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one was denied as a duplicate. Let me see what the original was.
[CUSTOMER][NEUTRAL] OK, yeah, because it looked like it was resubmitted.
[AGENT][NEUTRAL] Oh, OK, so this is the only one. Hold on one second.
[AGENT][NEUTRAL] So the original claim we paid out on, um, claim number 3541326.
[CUSTOMER][NEUTRAL] I'm sorry, 354-1326?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We were billed for $27.95 and we paid that full amount to the provider.
[CUSTOMER][NEUTRAL] OK, to the provider and that was for the same data service.
[AGENT][NEUTRAL] Mhm. 1111 of 24, Warren Clinic.
[CUSTOMER][NEUTRAL] Warren Clinic.
[CUSTOMER][NEUTRAL] And do you um have that uh was that payment through a check or was it through an EFT?
[AGENT][NEUTRAL] So it was a single check. Let me see.
[AGENT][NEUTRAL] So check number 2018562.
[AGENT][NEUTRAL] It was issued on
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Mhm. It was issued on [PII], but it's still outstanding. So I can um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let me verify the address, but I can go ahead and send this over to [PII] so she can check on the check and reissue it if needed. Um, but it looks like it was sent to [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] That's correct, that's the right address.
[AGENT][NEUTRAL] OK, so I'll send this to [PII] to check on the check. If it has been cleared or cashed, um, she would provide us with a copy of the cleared check. If not, then we would, um, reissue the check and have it sent out to you all.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, sounds good thank you so much [PII] um if I can just get a reference number for this call.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Well thank you so much uh I hope you enjoy the rest of your day, [PII].
[AGENT][POSITIVE] Thank you. You also could see, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, nope, that is all for now.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great day. Bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.