AccountId: 011433970860
ContactId: 354be7aa-4489-4b6a-8305-75b9aff645c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413660 ms
Total Talk Time (AGENT): 107195 ms
Total Talk Time (CUSTOMER): 115330 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/354be7aa-4489-4b6a-8305-75b9aff645c4_20250416T20:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling to check on a claim.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] 2,013,290.
[AGENT][NEUTRAL] You have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK. Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] [PII]. The amount 127.
[CUSTOMER][NEUTRAL] $7741 even.
[AGENT][NEUTRAL] OK, it looks like we received it several times. Let me pull it up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yeah, I received 66-2024. Looks like it was denied the same day.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] We needed a copy of the explanation of benefits. Let me see if we received it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See the claim again.
[AGENT][NEUTRAL] Um, that was on.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] 2 24 25, process 226 25 and
[AGENT][NEGATIVE] Like we, it was denied as a duplicate.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] OK, and um
[CUSTOMER][NEUTRAL] Uh, is that the original claim is denied for primary insurance DOB?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] All right. And I could see we have again sent it on [PII]. Could you please check, have you received that?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Uh, looks like, yes, we did receive that and making a payment of $500 to the member.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the date when you have received it?
[AGENT][NEUTRAL] Uh, perceived.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Receive [PII] and it looks like it was processed today.
[CUSTOMER][POSITIVE] Thank you so much. And is that is paid?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] May I have the paid amount?
[AGENT][NEUTRAL] Um, it looks like we paid to the member.
[AGENT][NEUTRAL] You would have to contact them for payment information.
[CUSTOMER][POSITIVE] Thank you so much for this information. And is it possible for you to send the explanation of benefits of the payment?
[AGENT][NEUTRAL] Um, it's not been generated yet.
[AGENT][NEUTRAL] So it will take a couple of days to generate.
[AGENT][NEUTRAL] And it says it was sent to the member.
[CUSTOMER][NEUTRAL] All right, since you have stated
[AGENT][NEUTRAL] It goes to the members of the provider.
[CUSTOMER][NEUTRAL] Uh, it is paid.
[CUSTOMER][NEUTRAL] It was just processed today and since it, it is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] needed to allow some time to get cash or if there is any statement that was already the payment was
[CUSTOMER][NEUTRAL] Made to the members?
[AGENT][NEUTRAL] It goes to the member since it was processed and sent to the member.
[AGENT][NEGATIVE] It won't go to the provider
[CUSTOMER][NEUTRAL] Um, it is already sent, or, uh, you want to allow time?
[AGENT][NEGATIVE] It won't go to the provider, no, it won't go to the provider because this was sent to the member.
[AGENT][NEUTRAL] So you'll have to contact the member for information.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] All right. And
[CUSTOMER][NEUTRAL] Can I have uh the claim number?
[AGENT][NEUTRAL] 359-0044.
[CUSTOMER][NEUTRAL] 35,900.
[AGENT][NEUTRAL] 44
[CUSTOMER][NEUTRAL] Could you please repeat that?
[AGENT][NEUTRAL] 359.
[CUSTOMER][NEUTRAL] It's 359-0044.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Thank you so much. And for my documentation uh purpose, I also want to know the original claim and the duplicate claim number for my reference. Could you please help me with that?
[AGENT][NEUTRAL] 356 856-5.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the other claim number, please?
[AGENT][NEUTRAL] 346-552-6
[CUSTOMER][POSITIVE] All right. Thank you. Thank you so much for your assistance. Have a great day. And for reference, can I use your name in today's today?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] All right, thank you. Thank you so much for your assistance.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too