AccountId: 011433970860
ContactId: 41d88e9f-5f1a-404a-9da2-c78f3250559e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549710 ms
Total Talk Time (AGENT): 178092 ms
Total Talk Time (CUSTOMER): 148910 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/41d88e9f-5f1a-404a-9da2-c78f3250559e_20250423T13:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. I am [PII] calling you from the office.
[AGENT][NEUTRAL] May I have your name again?
[CUSTOMER][NEUTRAL] Sure, that is
[CUSTOMER][NEUTRAL] [PII]. Can I have your last name as well?
[AGENT][NEUTRAL] Yes, it is [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure, so the callback number is going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number, give me a second.
[CUSTOMER][NEUTRAL] OK, on the insurance card, where can I see the policy number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I have a group number. Yeah, I have a group number. Like I'm not sure what exactly this policy number.
[CUSTOMER][NEUTRAL] I can provide you the number ID claim number.
[AGENT][NEUTRAL] What is the member ID that may be the same as the policy number for APL? What is that?
[CUSTOMER][NEUTRAL] OK, so the number ID it is 024.
[CUSTOMER][NEUTRAL] 658.
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] M as Michael, L like Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, let me repeat that to you. I have that as 02465815 ML 8.
[AGENT][NEUTRAL] Is that correct? Thank you. And that's the policy number for APL and what is the member's name and date of birth?
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So the number's name, it is [PII] and the date of birth it is [PII].
[AGENT][NEUTRAL] OK, thank you for that information I get. And again, are you calling for claim status or eligibility and benefits for this member?
[CUSTOMER][POSITIVE] Uh, clean status effectively.
[AGENT][NEUTRAL] OK, I can assist with that. You can also check claim status by visiting our secure portal at [PII], and on that website you'll be able to obtain an EOB as well. And what is that date of service and the total charge amount please so I can help you.
[CUSTOMER][NEUTRAL] Sure, so the data server it is.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $1440 1440 dollars even.
[AGENT][NEUTRAL] OK, that was [PII] for $1240 even.
[CUSTOMER][NEUTRAL] Uh, that is $1440.
[AGENT][POSITIVE] 400, thank you.
[AGENT][NEUTRAL] OK. I did not show that claim under this policy number. Give me one moment to look for an ID that or a member ID number that has that date range for it. One moment, please.
[AGENT][NEUTRAL] And I'll provide the information to you once I get that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me provide you with the correct policy number when you're ready.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the policy number is 02497488ML8.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just to confirm that is 02497488 ML 8.
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time?
[CUSTOMER][NEUTRAL] Sure, it is 02497488 ML 8.
[AGENT][NEUTRAL] Yes, that is correct. OK, let me search for that date of service for you, one moment.
[AGENT][NEUTRAL] Can you verify those procedure codes bill for the service date for the member?
[CUSTOMER][NEUTRAL] Yeah, it is 992-03 and 99 sorry 92,170.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it shows that the claim was received and it shows that it denied as stating the above reference claims appears to be a duplicate of our previously submitted expenses, but the payment has been made to the insured.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the details of the original thing.
[AGENT][NEUTRAL] The claim that was submitted by the provider was denied as the insured had already submitted the claim and benefits were paid to the insured.
[CUSTOMER][NEUTRAL] OK, so the insurer had already submitted the claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Actually I have a claim number on my end.
[CUSTOMER][NEUTRAL] Could you please check that?
[AGENT][NEUTRAL] If it's referring to the claim number that in regards to the provider, I can check that for you. What is that claim number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK, actually.
[CUSTOMER][NEUTRAL] It is C4B00CJJ.
[AGENT][NEUTRAL] I'm sorry, your voice was cutting out if you could repeat that.
[CUSTOMER][NEUTRAL] Oh apologies it is uh.
[CUSTOMER][NEUTRAL] Sure. It is 024.
[CUSTOMER][NEUTRAL] 97488.
[AGENT][NEUTRAL] OK, that is the policy number that I just provided you as far as the current policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can provide
[CUSTOMER][NEUTRAL] Actually on this one it is exact duplicate.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I'm sorry, again, the claim number, let me provide you with the claim number for the providers submitted claim when you're ready for that please for your documentation.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK. It is 356-575-1.
[CUSTOMER][NEUTRAL] You can go ahead.
[CUSTOMER][NEUTRAL] Again that is 356-5751 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And this claim was denied as duplicate.
[AGENT][NEUTRAL] This claim
[AGENT][NEUTRAL] In regards to the denial, it shows that the above reference claim appears to be a duplicate of a previously submitted expenses. Benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] OK, could you please provide me details of the original claim this claim was denied as a duplicate.
[AGENT][NEUTRAL] Uh, no, because the claim original claim was submitted by the insured. I'm not able to give that information to you.
[CUSTOMER][NEUTRAL] OK, so the insured need to contact you and get the information.
[AGENT][NEUTRAL] I'm [PII]orry?
[CUSTOMER][NEUTRAL] Uh, no problem. Uh, can I have the call reference number in you?
[AGENT][NEUTRAL] OK, we do not provide call reference numbers. Thank you. You can use my name and today's date. Is there anything else I can assist you with, please?
[CUSTOMER][POSITIVE] Uh, that's all. Thank you very much. Have a good one. Bye bye.
[AGENT][POSITIVE] And thank you for calling APL. Take care. Bye bye.