AccountId: 011433970860
ContactId: 3b6e074c-97b7-48e5-b7d6-91c706ebd903
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384119 ms
Total Talk Time (AGENT): 118685 ms
Total Talk Time (CUSTOMER): 127509 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/3b6e074c-97b7-48e5-b7d6-91c706ebd903_20250603T13:15_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the office. How are you doing today?
[AGENT][NEUTRAL] I'm sorry, it's really hard to hear you. Can you hear me?
[CUSTOMER][NEUTRAL] Yes I can hear you. Can you hear me now?
[AGENT][NEUTRAL] Yeah, you just sound really far away. I can hear you.
[CUSTOMER][NEUTRAL] OK, actually, uh, I'm calling from the doctor's office. My name is [PII]. First initial so the last name is [PII].
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] Actually, uh, the reason of my call is that I have a patient, and I just want to check the claim status for this patient, so could you please help me?
[AGENT][NEUTRAL] Yes, I can help you with the claim status and how many claims do you have today?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, give me one moment.
[CUSTOMER][NEUTRAL] OK, uh, the callback number, uh, gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] OK, and the member's policy number?
[CUSTOMER][NEUTRAL] The member's policy number is gonna be 02505495.
[AGENT][NEUTRAL] Alright, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]. 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. May I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Uh yes. The data service I have is can be.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $300 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Oh, wait a minute. Hold on one moment.
[AGENT][NEUTRAL] Alright, so we received the claim 3 times. Are you wanting the first claim?
[AGENT][NEUTRAL] That was received?
[CUSTOMER][NEUTRAL] Uh, no, the claim which we submitted there recently on I think.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so you want the last claim, that's denied as a duplicate. Were you wanting the original claim?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So we originally received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 5953.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Treatment in an outpatient facility in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] Yes, recently we received this denial, but after that, uh, we just submitted the correct claim.
[AGENT][NEUTRAL] Right, and it's been denied as a duplicate. Is there something showing that they were in the outpatient hospital more than 18 hours?
[CUSTOMER][NEUTRAL] Yeah, I understand. So, uh, what happened with the, uh, corrected claim? Why the claim got denied due to duplicate claim because you guys submitted the corrected claim.
[AGENT][NEUTRAL] Because it's still the same denial reason. Do you have something that showed that the claim was denied because they weren't in an outpatient hospital for more than 18 hours? Do you have something showing that they were in the outpatient hospital for more than 18 hours?
[CUSTOMER][NEUTRAL] OK, so you said the, uh, the claim which you submitted is denied due to duplicate and the original claim denied due to outpatient service is not covered, right?
[AGENT][NEGATIVE] Right, if it's less than 18 hours, it's not covered by the policy. So when you sent it again, it was denied because it was still less than 18 hours. They weren't in the hospital for more than 18 hours.
[CUSTOMER][NEUTRAL] OK, uh, what's the first initial to the last name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK, uh, [PII], could you please provide me the call reference number as well?
[AGENT][NEUTRAL] Sure, so there's no call reference.
[CUSTOMER][NEUTRAL] Before providing the reference number, uh, let me confirm the claim number which is 352-595-3, right? Which got denied on [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, what's your reference number?
[AGENT][NEUTRAL] It'll be my name in today's date.
[CUSTOMER][NEUTRAL] Your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for assisting. You have a great day. Bye bye.
[AGENT][POSITIVE] Yes, thanks for calling APL. Is there anything else I can help with?
[CUSTOMER][POSITIVE] Uh no, thank you so much.
[AGENT][POSITIVE] Alright, have a great day.