AccountId: 011433970860
ContactId: 603af5b8-9058-4b7a-9de8-082e5bd998e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280579 ms
Total Talk Time (AGENT): 101928 ms
Total Talk Time (CUSTOMER): 103983 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/603af5b8-9058-4b7a-9de8-082e5bd998e9_20250303T17:26_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 Miss [PII], my name is [PII] and I'm calling from Lexington Medical Center, and I'm calling, I'm calling regarding a claim that looks like it's denied as a duplicate but it's not. Could you help me with that please?
[AGENT][NEUTRAL] Sure, I can help you with the um claim. and Ms. [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, um, my number is [PII] and that's direct and the policy number is 0251837.
[AGENT][POSITIVE] 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] It'd be [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I think I'm missing the number. You said 251-837?
[CUSTOMER][NEUTRAL] Mhm 0025 I'm sorry dear let's start again [PII] so.
[CUSTOMER][NEUTRAL] I'm so sorry it's 0251837.
[AGENT][NEGATIVE] But it's still a number missing.
[CUSTOMER][NEUTRAL] Still number let me see if they got a copy of the card.
[CUSTOMER][NEUTRAL] OK, scan.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] I, I don't know, sweetie. I'm trying to find a card, see what, um, let me see they got 02518370. This is 0 on it mm 0 on the end. They didn't put that on there, so let me put on it now coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 70, OK.
[AGENT][NEUTRAL] And then, um, you already verified the first and last name and date of birth. So thank you for verifying and then what's the um claim number or the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, data service is gonna be 11-14-2024.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what's the total bills?
[CUSTOMER][NEUTRAL] $1,503 even.
[AGENT][NEUTRAL] OK, so this is a duplicate.
[AGENT][NEUTRAL] What's the orig, this is the original.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just getting everything together. Hold on one moment. OK, so 5, the claim number ending in 3562587.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's the claim that's as the duplicate.
[AGENT][NEUTRAL] The original claim, um, those claim number 3,539,680.
[CUSTOMER][NEUTRAL] OK, I got that.
[AGENT][NEUTRAL] Um, and it was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Right, and I sent that off on uh [PII], and I think that's when it denied that second one when it denied the duplicate.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] This one was denied the second one. OK, so let me pull that up and see what was received. Hold on one second.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, OK, so because this is just the claim form, um,
[AGENT][NEGATIVE] Like there's only one page, there's nothing else attached to this.
[CUSTOMER][NEUTRAL] OK, I guess it must have got lost in transit because I sent both of them over to to over I sent the claim and the and the Medicaid you'll be.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] One on one, yeah.
[AGENT][POSITIVE] Yes, um, so yeah, you can definitely resend it though.
[CUSTOMER][NEUTRAL] OK, so the uh claim number is gonna be ending in 680, correct? That one that's what I need to put on the form.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII]. Can I get a call reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you [PII].
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you sweetie you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.