AccountId: 011433970860
ContactId: 597c4cbe-0f41-43c8-baa4-847a10b8b8e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 727619 ms
Total Talk Time (AGENT): 261930 ms
Total Talk Time (CUSTOMER): 167364 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/597c4cbe-0f41-43c8-baa4-847a10b8b8e6_20250613T13:03_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], good morning. This is [PII]. Last name [PII], calling from provider office looking for status of a claim.
[AGENT][NEUTRAL] OK, in the beginning, you said your name kind of fast. Can you repeat your name for me please and provide a good contact number?
[CUSTOMER][NEUTRAL] [PII] and the callback number is [PII] direct line.
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 025657664.
[AGENT][POSITIVE] Thank you. And I'll be more than happy to help with the claim status, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Two plans.
[AGENT][NEUTRAL] All right, is it the same member or different members?
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] And will you need a copy of the explanation of benefits for each claim we go over?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's a good fax number to fax the explanation of benefits to?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] No, it's [PII] Last name [PII]
[AGENT][NEUTRAL] OK, so fax number [PII].
[AGENT][NEUTRAL] Attention, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll be sending both at the end of the call. May I have the first patients um policy number?
[CUSTOMER][NEUTRAL] Um, actually I provided it to you earlier.
[AGENT][NEUTRAL] I'm sorry, 256-576-4.
[CUSTOMER][NEUTRAL] 02567.
[CUSTOMER][NEUTRAL] 02565764
[AGENT][NEUTRAL] OK, so yes, that's correct. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth, [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] The service is for [PII] charge amount $277.
[AGENT][NEUTRAL] Thank you and can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] As a physician of Candle Lake LLC.
[AGENT][NEUTRAL] Thank you. I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 2096.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] And we have submitted this claim as a primary.
[AGENT][NEUTRAL] Right, but this is a secondary insurance, so that's why we're requiring or asking for the explanation of benefits from primary from primary. Did you need the primary insurance name?
[CUSTOMER][POSITIVE] Yes, please provide.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Member ID.
[AGENT][NEUTRAL] Uh, we don't have any information from the primary. You'll have to get that information from the insured. I'm sorry.
[CUSTOMER][NEUTRAL] And the reference number for this?
[AGENT][NEUTRAL] The reference number for the entire call will be my name and today's date, and again, that's [PII] my [PII] is [PII].
[CUSTOMER][NEUTRAL] OK, the next day?
[AGENT][NEUTRAL] Um, hold on one moment, let me note this policy.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Just a moment, ma'am. I'm pulling up the account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number is 01822309 M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] So the service is for [PII]. Taj211 dollars even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so for this one, the policy number 1822309 is no longer active. It was effective from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] There is an active policy. Um, let me get that policy number and see if the claim is under there, and I'll give you the number as well.
[AGENT][NEUTRAL] Um, so policy number 2443496.
[AGENT][NEUTRAL] Has been active since [PII].
[AGENT][NEUTRAL] I'm getting ready to pull that so I can see if there's a claim there for you.
[AGENT][NEUTRAL] All right, so we received this claim twice. The first claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 8261.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Just a moment, ma'am. Uh, please provide me the uh first name that you received information.
[AGENT][NEUTRAL] Again, when the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 8261
[AGENT][NEUTRAL] And on [PII], claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We received the claim again.
[CUSTOMER][NEUTRAL] And the second one.
[AGENT][NEUTRAL] We received this again on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 551 6.
[AGENT][NEGATIVE] And on [PII], the claim was denied as a duplicate. The explanation of benefits from primary insurance was not received.
[CUSTOMER][NEUTRAL] Denied as a duplicate or?
[AGENT][NEGATIVE] Denied as duplicate.
[CUSTOMER][NEGATIVE] Denied for primary insurance.
[AGENT][NEUTRAL] Duplicate of the original claim, which was denied requesting the explanation of benefits for primary insurance.
[CUSTOMER][NEUTRAL] OK. And you have provided me earlier the effective date, uh the uh uh member ID was, uh which was termed, right? That was [PII]. And the term date, ma'am?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, the inactive uh member ID termed it.
[AGENT][NEUTRAL] That's what I'm giving you, sir. The policy was active from [PII]. The new policy became effective on [PII]. The term date that you're asking for is [PII].
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] No, for the active policy term date.
[AGENT][NEUTRAL] It's still active, sir. There's no time or date.
[CUSTOMER][NEUTRAL] And the policy number is 2443096, right?
[AGENT][NEUTRAL] No. The active policy number is 244.
[AGENT][NEUTRAL] 3496.
[CUSTOMER][NEUTRAL] OK. And what about the primary insurance detail?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The primary insurance is United Healthcare.
[CUSTOMER][NEUTRAL] OK, just a moment, let me check the claims mission.
[CUSTOMER][NEUTRAL] 0224.
[CUSTOMER][NEUTRAL] OK, and we have submitted these claims as a primary and we need to submit this claim to UFC, right? First, after that to you.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] We submitted both the claims. Yeah. OK. That's fine. OK, no problem. Thank you. Have a nice day. Goodbye.
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am, you should for me. Have a nice day. Goodbye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1200.
[CUSTOMER][NEUTRAL] 764
[CUSTOMER][NEUTRAL] 942