AccountId: 011433970860
ContactId: 6435d5b4-a1e7-42f6-8a16-1809c896f7f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400450 ms
Total Talk Time (AGENT): 113899 ms
Total Talk Time (CUSTOMER): 71209 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/6435d5b4-a1e7-42f6-8a16-1809c896f7f6_20250123T21:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check claim status for the patient.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] OK, so there is no extension?
[CUSTOMER][NEUTRAL] No extension. It's a direct line.
[AGENT][NEUTRAL] OK, OK, thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Mhm. The policy number is 018.
[CUSTOMER][NEUTRAL] 49205.
[AGENT][NEUTRAL] OK [PII] thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] One second, [PII]. I'm sorry about the delay.
[CUSTOMER][POSITIVE] Mhm, no problem. Take it on time.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's name is uh [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Mhm. The date of service is [PII] and the charges is $3,968 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Just one moment. Give me just a moment, [PII], to look at a couple of things.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Sure, sure.
[AGENT][NEUTRAL] And the name of the group that you're calling on behalf of the provider group?
[CUSTOMER][NEUTRAL] Mhm. Sure. The facility name is Anastasia Physician Solutions of South Florida LLC.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so we have received this claim more than once. The most recent received claim was denied as a duplicate. Do you need the original claim information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me a moment please on that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I am not gonna be able to provide you detailed information, [PII], on, on this claim, um, the provider, I can provide you the claim number for the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] However, this claim was also filed by the insured, so you would have to contact the insured for information regarding the initial.
[AGENT][NEUTRAL] Claim
[CUSTOMER][NEUTRAL] For this particular claim alone or uh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know the reason for that?
[AGENT][NEUTRAL] This claim was
[AGENT][NEUTRAL] Because the insured filed a claim.
[AGENT][NEUTRAL] Before the provider did.
[AGENT][NEUTRAL] The provider's claim number is 3533321.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] OK. Have you paid to the patient?
[AGENT][NEUTRAL] You would have to contact the member regarding any further information on that claim, [PII].
[CUSTOMER][NEUTRAL] For that, so.
[CUSTOMER][NEUTRAL] OK, can I have a call reference number?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for [PII]. Have a wonderful rest of the day. Stay safe. Bye-bye.
[AGENT][POSITIVE] Well, you are very welcome. I hope you have a nice evening as well, and I hope you stay safe too. And thank you again, [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.