AccountId: 011433970860
ContactId: 4b42892c-4d22-475d-9d9e-4a0a52a73579
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610070 ms
Total Talk Time (AGENT): 226031 ms
Total Talk Time (CUSTOMER): 129796 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/4b42892c-4d22-475d-9d9e-4a0a52a73579_20250519T14:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from Para office checking on the status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] I have 2 claims.
[AGENT][NEUTRAL] Are they for the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, it's a different patients.
[AGENT][NEUTRAL] OK, [PII], I can help you with this. And what is your callback number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you and [PII] you will use my name and today's date as each of your call reference numbers. Also, any information that I provide for you today will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print that by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK. And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the first person policy number it is 010124.
[AGENT][NEUTRAL] I'm sorry, say the number again?
[CUSTOMER][NEUTRAL] It is 010124.
[AGENT][NEUTRAL] OK, that we're missing a number.
[AGENT][NEUTRAL] You said 010124?
[AGENT][NEUTRAL] That's not enough. OK. All right, so let me check that. So first off in, OK, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the patient's name, it is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that number that you gave me pulls up a completely different policy for a different member. Do you have a copy of the ID card with the correct information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] I just check out that
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And the different one, it shows here.
[CUSTOMER][NEUTRAL] 02462268.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 7.
[AGENT][NEUTRAL] OK, did you say 02462268?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And again your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and the patient's date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, data service is on [PII]. And the total bill amount is $88,599.16.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said the date of service is [PII], is that correct?
[CUSTOMER][NEUTRAL] No, it is [PII].
[AGENT][NEUTRAL] OK, so I show there was a claim received on [PII] and processed the same date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359-7014.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $496.41.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was paid with check number 2042529.
[AGENT][NEUTRAL] And the remark that goes along with this payment states that with this payment of this check, the policy maximum for this benefit has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And this check has been issued as a single check or double check?
[AGENT][NEUTRAL] As I stated, it's a single check.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And can, can you please verify the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. That's right.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Thank you. And for the, for the UB we have to check in the portal, right? You said?
[AGENT][NEUTRAL] Yes, sir, that is correct. One was also sent with the payment, but you may also print it from the portal.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. Can we go with the next member?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the next member's policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the next member policy number it is 02496781.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name, it is [PII], sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII]. And the total bill amount is $19,584.90.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim has been received a total of 4 times. The last 3 times that it was received, [PII], it was denied as a duplicate of previously submitted expenses. Do you need the original claim status?
[CUSTOMER][NEUTRAL] Yes, please. I need the original one.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The claim number is 353-0365.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim was denied. It states insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So it's not payable.
[AGENT][NEUTRAL] Yes, it's the remark on here states insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. Uh any other for today?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, wonderful day. Thanks for giving the information.
[AGENT][POSITIVE] Oh, well, you're very welcome. Is that all that I can help you with today?
[CUSTOMER][POSITIVE] Yes, there is nothing else. Thanks for asking.
[AGENT][POSITIVE] OK, [PII], well then, thank you again for calling APL and I hope you have a great day also.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.