AccountId: 011433970860
ContactId: 18721c2b-0822-4c95-b348-c45263ea8508
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321850 ms
Total Talk Time (AGENT): 129792 ms
Total Talk Time (CUSTOMER): 105774 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/18721c2b-0822-4c95-b348-c45263ea8508_20250401T18:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. My last name is [PII], calling on behalf of provider's office to check the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah. Uh, it's 024734.
[CUSTOMER][NEUTRAL] 03
[CUSTOMER][NEUTRAL] M for Mike, L for Leo, 8.
[AGENT][NEUTRAL] And then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] and the last name is like uh I spells [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, [PII] with the charge amount of $2,444 even.
[AGENT][NEUTRAL] OK, I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and that bill amount was $4,444?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK all right thank you one moment.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm sorry, [PII], was that $2,444?
[CUSTOMER][NEUTRAL] Yes, 2444.
[AGENT][NEUTRAL] OK, got it, thank you and then what was the name of this uh the provider's office this was with?
[CUSTOMER][NEUTRAL] Uh, it's [PII] Anesthesia Associate.
[AGENT][NEUTRAL] Got it. OK, thank you. Let's see, so we did receive this claim, uh, we were unable to pay a benefit as the maximum benefit payable for the date of service had been met. There was another claim filed for this date of service that had already been paid.
[CUSTOMER][NEUTRAL] One second. Uh, for the same date of service you're saying?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But we have only one claim on this data service. We didn't have any other claim. We have only the one.
[AGENT][NEUTRAL] It's from a different provider.
[AGENT][NEUTRAL] Right, there's another claim from a different provider from the same date of service.
[CUSTOMER][NEUTRAL] Different provider.
[CUSTOMER][NEUTRAL] On the same date of service there but there is a different provider, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Under VC plan or dollar plan, maximum benefits has reached.
[AGENT][NEUTRAL] Under this patient's plan, this is a secondary medical plan.
[CUSTOMER][NEUTRAL] I mean, uh, under visits, how many, how many visits or, uh, like, uh, how many dollars?
[AGENT][NEUTRAL] Oh no, no, it's the dollar amount so their outpatient benefit is on a per calendar day basis so it pays up to $300 max per calendar day and that had been paid for another claim that was filed on the same date of service.
[CUSTOMER][NEUTRAL] On for the another provider on the same date of service, right? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh we don't have the UV. Can you please send the UV and uh can I get the, what is the received date and the process date?
[AGENT][NEUTRAL] Yes, um, so we received this claim [PII], and it was processed [PII].
[AGENT][NEUTRAL] And then what was that uh fax number for you? I can send this EOB to you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Can I get, uh, can I get the claim number? I will get the fax number also.
[AGENT][NEUTRAL] Sure, the claim number is 3569847.
[CUSTOMER][NEUTRAL] Yeah, my fax number is 833.
[CUSTOMER][NEUTRAL] 642-042-6. Attention to my name, [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that number back to you to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, alright, I will go ahead and get that sent to you. You should get it here within about 10 minutes. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, just call back, call reference number.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] OK, OK. I think that's it from mine and thank you for assisting me.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Bye bye.