AccountId: 011433970860
ContactId: 26ddda70-5c01-492d-bf31-02ff71d9525b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458429 ms
Total Talk Time (AGENT): 143197 ms
Total Talk Time (CUSTOMER): 105006 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/26ddda70-5c01-492d-bf31-02ff71d9525b_20250317T19:16_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] Um, hi, [PII]. Um, this is [PII], and I'm calling to follow up on a claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Um, yeah. The, my direct line is [PII]. The member ID is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, that will be [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 date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Thank you. And the total bill amount?
[CUSTOMER][NEUTRAL] $1430.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, where's the right, and [PII], do you mind if I place you on just a brief hold while I look at the claim? All right, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So we paid out on the same client. Wait a minute, what?
[AGENT][NEUTRAL] We paid out on the same claim twice. This has to be a different.
[AGENT][NEUTRAL] 985, we paid 8334.
[AGENT][NEUTRAL] What do we pay on all?
[AGENT][NEUTRAL] 73721.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] This is the same claim.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I just wanted to check with you. I'm looking at the claim on the the claims on the other end, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Is this correct? Maybe, let me see if maybe the patient submitted one and
[AGENT][NEUTRAL] Oh no, that's a provider.
[AGENT][NEUTRAL] OK, no.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] This is funny.
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm great how are you?
[AGENT][POSITIVE] I'm doing good. Um, can you look at something with me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's um policy number 213.
[AGENT][NEUTRAL] 7840.
[CUSTOMER][NEUTRAL] OK, [PII] and [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the date of service is [PII].
[CUSTOMER][NEUTRAL] For which one?
[AGENT][NEUTRAL] Oh, I'm sorry, part one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and which claim number?
[AGENT][NEUTRAL] OK, so it's really all 3, so she was calling for a claim status.
[AGENT][NEUTRAL] And we are, so can we pay?
[AGENT][NEUTRAL] Two of these claims are the same exact claim, it's just two different claim numbers, but we paid it twice.
[CUSTOMER][NEUTRAL] OK let me see.
[AGENT][NEUTRAL] It's the um 985 and the 990.
[CUSTOMER][NEUTRAL] Yeah let's see if they are the same actual provider.
[CUSTOMER][NEUTRAL] I'm just gonna look at the provider's name in the box one moment.
[CUSTOMER][NEGATIVE] Come on, it's so slow.
[CUSTOMER][NEUTRAL] OK, so yes, that is the same.
[CUSTOMER][NEUTRAL] Looks like we did pay this twice because it's the same um provider.
[AGENT][POSITIVE] Cool. Mhm.
[CUSTOMER][NEUTRAL] Inbox 31, so let's see, looks like.
[CUSTOMER][NEUTRAL] The 70,990 would need to be.
[CUSTOMER][NEGATIVE] Requested um refund on.
[AGENT][NEUTRAL] OK, so, because she was calling for a claim status, but I just noticed this, so how
[AGENT][NEUTRAL] So what am I gonna, so I need to tell her what I can tell her this. I just want to make sure.
[CUSTOMER][NEUTRAL] No, I would tell her that it processed under the 337-0985 and give her that information for that one and then do your hub request on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The 990 and they need to request the refund on that one.
[AGENT][POSITIVE] Very close, very fine. OK, I got it. Thank you so much because I was very confused.
[CUSTOMER][POSITIVE] OK. You're so welcome. You call me anytime, no problem.
[AGENT][POSITIVE] OK, have a good day.
[CUSTOMER][NEUTRAL] You as well. Bye-bye.
[AGENT][NEUTRAL] All right, bye bye.