AccountId: 011433970860
ContactId: 799490ed-627a-4f3a-a437-1889858d18ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503260 ms
Total Talk Time (AGENT): 229097 ms
Total Talk Time (CUSTOMER): 94757 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/2025/06/06/799490ed-627a-4f3a-a437-1889858d18ae_20250606T12:55_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] Hello, my name is [PII], and I'm calling to know about the claim status.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, [PII], thank you. And what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Mm. It's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. It's 1578809.
[CUSTOMER][NEUTRAL] M for Mike, L Lima, 8.
[AGENT][NEUTRAL] OK, [PII], thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII], that I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] I'm sorry. The first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] So, this date is [PII] and the total bill amount is $50.
[AGENT][NEUTRAL] I'm so sorry, what was the bill amount?
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] 50
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so [PII], um, any, again, any information provided is a verification of benefits and not a guarantee of payment. There is no claim on file for this member for this data service.
[AGENT][NEUTRAL] And this policy was not active for this state of service. The effective date on the policy had been [PII] and it termed as of [PII], and she does not have a policy active with our company for your date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can you provide me your reference number for this call?
[AGENT][POSITIVE] Yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have one more thing. Please check that too. Let me go back.
[AGENT][NEUTRAL] I'm so sorry. Well, what did you say, [PII]?
[CUSTOMER][NEUTRAL] I said I have one more claim.
[AGENT][NEUTRAL] For the same patient.
[CUSTOMER][NEUTRAL] No, the patient is different.
[CUSTOMER][NEUTRAL] Um, are you ready for the next member ID?
[AGENT][NEUTRAL] No, ma'am, cause I didn't, you did not say that you had more than one initially. So just one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] Mm it's 01822309.
[CUSTOMER][NEUTRAL] Mike Lima 8.
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] You want me to repeat it?
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] And what is your patient, same with this one, any information provided will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. Now, this policy is also an old policy.
[AGENT][NEUTRAL] That was active from [PII]. What is your date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment I have to write it.
[CUSTOMER][NEUTRAL] You said it's [PII]. Am I right?
[AGENT][NEUTRAL] [PII]. What is your date of service? There is another policy that is active.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The date of service for is for [PII]. So,
[CUSTOMER][NEGATIVE] I got that it's not active.
[AGENT][NEUTRAL] I'm OK, so what is the data service because there is another policy that I will provide you the information on that is active. What is your data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Build them out?
[CUSTOMER][NEUTRAL] $211.
[AGENT][NEUTRAL] Thank you. So the current policy or correct policy number that you should have is going to be 244.
[AGENT][NEUTRAL] 3496.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And one moment for me to check the claim status to see if we received it and processed it under the correct policy number.
[AGENT][NEUTRAL] OK, so the most recently received claim for this member was denied as a duplicate of previously submitted expenses. Do you need the original claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The original claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 8261.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the reason for the denial is that we need a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mm, but, uh, on my behalf, this is the primary insurance.
[AGENT][NEUTRAL] It is not. We are not a major medical insurance company. This would be a supplemental policy to the primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][POSITIVE] OK, thank you so much ma'am.
[AGENT][NEUTRAL] Yes, ma'am. And if you need a copy of that explanation of benefits with that remark, you can print it from our portal now that you have the claim number by going to [PII].
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] OK.