AccountId: 011433970860
ContactId: 73e6f511-7da3-4e88-a43b-0567325c44c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425709 ms
Total Talk Time (AGENT): 135436 ms
Total Talk Time (CUSTOMER): 91985 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/73e6f511-7da3-4e88-a43b-0567325c44c0_20250403T14:57_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] here calling you from provider's office and looking for a claim status.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have the spelling of your name and the callback number?
[CUSTOMER][NEUTRAL] It's [PII] and initial to my last name is [PII] And how about yours? Can you please help me out with your name?
[AGENT][NEUTRAL] My name is [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. And the callback number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the policy number, [PII], that you're calling?
[AGENT][NEUTRAL] Regarding today.
[CUSTOMER][NEUTRAL] Uh, the policy number that I'm looking today is 02544969.
[AGENT][NEUTRAL] 69 or 65?
[CUSTOMER][NEUTRAL] 69.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify?
[AGENT][NEUTRAL] You're calling to verify benefits or to check the status of a claim?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for and I'll be able to assist you.
[CUSTOMER][NEUTRAL] It's [PII] for the amount of $914 even.
[AGENT][NEUTRAL] And what is your procedure code?
[CUSTOMER][NEUTRAL] It's D 0279 and the other one is 77065.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. [PII], there was no payment made on this claim.
[AGENT][NEUTRAL] And the reason why there was no payment made on this claim is because the benefits were paid to the insured.
[CUSTOMER][NEUTRAL] Why
[AGENT][NEUTRAL] Because the insurer submitted a claim.
[CUSTOMER][NEGATIVE] I didn't understand like what are you trying to say.
[AGENT][NEUTRAL] So there was no payment made on the claim due to the claim being a duplicate of a submitted claim by the insured.
[CUSTOMER][NEUTRAL] What is the original claim status?
[AGENT][NEUTRAL] No, that's not what I stated. I stated I can only give you information in regards to your claim that you submitted, and the the information in regards to your claim that you submitted is that this claim is considered as a duplicate submitted by the insurer. So therefore no payment was made on your claim. Is there anything else that I could assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] Your claim number is 354-7183.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you allow me a moment? Can I place your call on hold for a minute?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Please be on the line.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for holding the line.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you, [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII], is it possible for you to provide me the original?
[CUSTOMER][NEUTRAL] Yeah. Is it possible for you to provide me the original claim number at least?
[AGENT][NEUTRAL] Um, I can only provide you with your claim number. I can't provide you with the insured claim number because you did not submit that claim, so that'll be violation of HIPAA.
[CUSTOMER][NEUTRAL] That means we have to bill this claim to the member? Is it what are you doing sir?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So this is not a primary insurance, this is a gap insurance. The only thing that I can tell you, [PII], is that we did not make a payment on the claim that you submitted here. However, if that's what you choose to do is send them the member a pay a bill, then that's your decision. However, I can't tell you what to do in regards to that unfortunately.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no problem. Thank you so much for helping me out. What is the call reference number?
[AGENT][NEUTRAL] You don't provide reference numbers, [PII]. However, you can use my name and today's date as a reference. It's [PII] and today's date is a reference. Thanks for calling APL, [PII], and have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks. Goodbye.