AccountId: 011433970860
ContactId: 1dc3067f-a3f2-46c6-8a59-7fdabbecb332
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680770 ms
Total Talk Time (AGENT): 260453 ms
Total Talk Time (CUSTOMER): 221284 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/1dc3067f-a3f2-46c6-8a59-7fdabbecb332_20250204T21:26_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII]. I'm calling from provider's office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing well, thank you so much for asking, [PII]. Could you please help me to check on a claim status?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, I can help you with the claim status and how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Actually just one.
[AGENT][NEUTRAL] All right. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, the, uh, sorry.
[CUSTOMER][NEUTRAL] I'm sorry, just a second. The callback number is [PII]. And the policy number here is 02022379ML7.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you. Hold on one moment. Do you mind if I place you on just a brief hold while I get the policy for you?
[CUSTOMER][POSITIVE] Sure, take your own time, I'm here.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding, [PII] and I have the policy here. Can you verify the member's first and last name and date of birth?
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Sorry, I'm sorry. Uh, the uh the member name here is [PII] and the date of birth is [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 for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yes, it is uh [PII] and the billed amount here is, yeah, it ranges to uh [PII] and the bill amount is $38,209 even.
[AGENT][NEUTRAL] OK, thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Alright, so there's no claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Actually um.
[CUSTOMER][NEUTRAL] Once again, yeah, actually, the previous, uh, rep, uh, told me to, uh, that the claim has been denied as duplicate and there is a claim which has been paid and I forgot to get the information for the paid claim. Uh, that's why I called.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, wait a minute. Hold on 1 2nd. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Yeah, take your time, I'm here.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] So you called the last note that we have, you, um, someone called on [PII] for the same claim status [PII], the same dollar amount. We verified and we advised that there was no claim on file and we gave the claim mailing address. Who did you speak with in reference to the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Is that so? Uh, just a second.
[CUSTOMER][NEUTRAL] Uh, I spoke with [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You spoke with [PII]? OK, she's in claims, and it was for this amount?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have the claim number of the duplicate.
[AGENT][NEUTRAL] And when did you speak with?
[AGENT][NEUTRAL] Yes, what's the claim number?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] 3521735
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] A number
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] They can
[AGENT][NEUTRAL] OK, this is a different claim. This is a different policy number. This is policy number 2473395. So hold on one second, let me go to that policy number. That's why I can't find it under this one.
[CUSTOMER][NEUTRAL] I said so.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I think maybe I mixed um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I missed uh missed.
[CUSTOMER][NEUTRAL] Something here and there.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, so the claim number that you gave me um turned on [PII], the claim number that this was processed under is the active um policy number of 2473395. So I'm going to look under this policy for that claim and you're needing what information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you provide me this?
[CUSTOMER][NEUTRAL] Could you provide me the account number?
[CUSTOMER][NEUTRAL] Of the patient
[AGENT][NEUTRAL] Yes, the active, the active policy number that this claim is processed under is 247.
[AGENT][NEUTRAL] 3395.
[CUSTOMER][NEUTRAL] OK, let me check with that policy number.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Uh, is that an account number or?
[CUSTOMER][NEUTRAL] Uh, I want the account number of that policyholder, so I can pull that uh pay.
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Are you asking me for the patient account number that you provide or their policy number here with APL?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the policy number with the APL you told.
[AGENT][NEUTRAL] So the patient had two policies. The policy number that you gave 2022379 was active from [PII].
[AGENT][NEUTRAL] The currently active policy is 2473395 and it has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm going to look under the new policy now for this um claim number that you gave to get that information for you that you're needing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 135. OK, so the insured submitted it first, that was the initial claim, and then 3521735 was denied.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so the, the, so 3521735 was denied as a duplicate of the original claim, which was denied for, let me see what that claim was denied for.
[AGENT][NEUTRAL] The original claim was paid. What is it that you're trying to figure out?
[CUSTOMER][NEUTRAL] Uh, I want the claim number of the paid UB.
[AGENT][NEUTRAL] The paid EOB is to the provider, I'm sorry, it's to the insured, it's the insured's claim, so we can't give that information. We can just give your provider claim, which was a duplicate because they filed it first.
[CUSTOMER][NEUTRAL] So the patient filed it first, is that right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, actually, I'm not getting that information. Actually, we have filed a claim.
[AGENT][NEUTRAL] The patient filed the claim. The patient's claim was received on [PII] and processed on [PII]. Your claim did not, was not received until [PII].
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You can't provide me the claim number of the pay DUV.
[AGENT][NEUTRAL] I cannot because it's the member, it's the insured's claim.
[CUSTOMER][NEUTRAL] I just need the claim number so I could pull up the patient's info I have the, all the information of this patient. I just require the claim number.
[AGENT][NEUTRAL] I understand, but legally it's not your claim, so I can't I can't disclose their claim information. You can, however, reach out to the insured and see what the outcome of that claim was from June, but we cannot give you any claim status other than the claim you filed.
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, I'll try to check on that. Um,
[CUSTOMER][NEUTRAL] So, uh, it can't be, uh, I can't get the information as the patient has filed that claim.
[AGENT][POSITIVE] That's correct. You're correct.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII].
[CUSTOMER][NEUTRAL] Uh, that's what I required.
[CUSTOMER][NEUTRAL] The call reference number, please?
[AGENT][NEUTRAL] Was it
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, uh, [PII], for your patience and assistance. Have a great day.
[AGENT][POSITIVE] You also and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.