AccountId: 011433970860
ContactId: 0da34f6e-d756-4b14-a42f-572636c49c92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364799 ms
Total Talk Time (AGENT): 123118 ms
Total Talk Time (CUSTOMER): 145564 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/0da34f6e-d756-4b14-a42f-572636c49c92_20250424T17:42_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, this is [PII] calling to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy ID is 02435175 M as in Mike L as in Lima 7.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Merchandise, [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] 98 2024 or $29,553 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you calling in reference to the original claim or the um duplicate?
[CUSTOMER][NEUTRAL] I'm calling for the claim with the claim number 3515328 which is denying for primary insurance GOB. Could you please check on that? We have sent it again.
[AGENT][NEUTRAL] Right, so you need the second one.
[AGENT][NEUTRAL] The duplicate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so that one was received. The second one was received on [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 624.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Claim number is 54.
[AGENT][NEUTRAL] 574 9.
[CUSTOMER][NEUTRAL] 574 9.
[AGENT][NEUTRAL] And on [PII], the claim was denied as a duplicate.
[CUSTOMER][NEUTRAL] And on [PII], the claim was denied and the
[CUSTOMER][NEUTRAL] One moment. And uh with uh may I know why it is getting denied for duplicate since uh we have submitted with the primary EOB. Could you please check?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I'm checking. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh, sure.
[AGENT][NEUTRAL] So I'm just searching the documents that were sent in, um, it's coming up now.
[CUSTOMER][NEUTRAL] Mhm, sure.
[AGENT][NEGATIVE] So there's no explanation of benefits. It's only one page. It's the
[CUSTOMER][NEUTRAL] So there's no explanation only one page it's the claim form. All right. And uh
[AGENT][NEUTRAL] Claim form.
[AGENT][NEGATIVE] And that's it. There's no second page.
[CUSTOMER][NEUTRAL] Uh, for my documentation purpose, could you please tell me when the original was received and denied?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry. Uh, when the original claim is received and when it is denied?
[AGENT][NEUTRAL] Hold on one moment. It was received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And the original one is denying for primary UB right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, thank you. And uh can we submit again the claim uh with the primary UB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, just the you be enough? Yes.
[AGENT][NEUTRAL] Um, just the EOB is enough.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Could you please help me with your mailing address and fax number?
[AGENT][NEUTRAL] Sure. The mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] And that's APL claims department.
[CUSTOMER][NEUTRAL] And that's APO claims department.
[CUSTOMER][NEUTRAL] It's not required.
[AGENT][NEUTRAL] And our fax number is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][POSITIVE] Thank you. And the timely filing limit, please?
[AGENT][NEUTRAL] No, there's no timely filing limit. Um, as long as the policy is active, you can file it any time, but this is additional information, so once we receive it, we'll continue processing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right. Thank you so much. And the attention will be APO claims department.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And can I get a reference number for a call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. And again, that's [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for your assistance, [PII]. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You also, [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] All right, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you