AccountId: 011433970860
ContactId: 3f167959-68e6-4a89-9b94-0b62a8b7f8e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515808 ms
Total Talk Time (AGENT): 123265 ms
Total Talk Time (CUSTOMER): 114151 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/3f167959-68e6-4a89-9b94-0b62a8b7f8e3_20250527T19:01_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for JLR Medical Group Anesthesia. We need to check with the claim status. And before that, previously I tried to call someone talking to me, but they give a claim information. Unfortunately, claim got, uh, call got disconnected. So could you please assist me the claim information again?
[AGENT][NEUTRAL] Yes, I can assist you with the claim, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's a direct line. There is no another extension.
[AGENT][NEUTRAL] OK. And may I have the um member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member ID number I can see here is
[CUSTOMER][NEUTRAL] Give me a second
[CUSTOMER][NEUTRAL] It is 01813082.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, first name is.
[CUSTOMER][NEUTRAL] [PII], it's [PII]. Last name is [PII]. Patient 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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Sure. The service here, that's gonna be [PII]. Total charge amount is $2460 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the um provider's name on the claim?
[CUSTOMER][NEUTRAL] Sure, provider's name here, the individual, we have filed two claims for the same patient and same date of service and same charge amount, the different age. Can you hear me?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] No, you sound very far away. Can you repeat that, please?
[CUSTOMER][NEUTRAL] OK. So we have filed two claims for the same patient and same date of service and same charge amount.
[AGENT][NEUTRAL] 52 claims.
[AGENT][NEUTRAL] Do you mean 52 claims?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I can assist you with the 1st 5 of the others can be found on the online service center. So, for this claim though,
[CUSTOMER][NEUTRAL] No. Uh, what is happening, the same patient have two claims for the same dose and same date of service and same charge amount. The two different individual provider name and two different modifier only different. OK, I will go with the date of service.
[AGENT][NEUTRAL] OK, OK. Hold on one second. Hold on, hold on, hold on. I'm trying to make sure I understand you. How many claims do you have today? Because I don't know what 52 is.
[CUSTOMER][NEUTRAL] No, I have only one patient, one claim. That patient has
[AGENT][NEUTRAL] How many claims?
[CUSTOMER][NEUTRAL] 2. The same patient has 2 claims.
[AGENT][NEUTRAL] OK, so you have 2. OK, just if you can just answer the questions I asked just for clarity. So you have a total of 2 claims. OK, so for this claim, can you verify the name of the provider's office that is on the claim?
[CUSTOMER][NEUTRAL] JLR Medical Group, anesthesia.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So this claim was received on [PII]?
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 532 8.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] And I'm getting the denial reason now. Hold on one moment.
[AGENT][NEUTRAL] OK, so it says information received from provider incomplete cannot process until additional or corrected information is received. So let me see what was asked.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so for this one, [PII], do you mind if I place you on just a brief hold? I'm trying to see what the additional information is that was requested.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what's the additional information though?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.