AccountId: 011433970860
ContactId: 896d1ddf-b724-438b-8010-3d1e85b148a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406380 ms
Total Talk Time (AGENT): 95788 ms
Total Talk Time (CUSTOMER): 115599 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/896d1ddf-b724-438b-8010-3d1e85b148a7_20250320T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you today?
[AGENT][POSITIVE] Good how are you?
[CUSTOMER][POSITIVE] I'm doing good and great. [PII], my name is [PII] and I need your help regarding the claims.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today, [PII]. Do you have the patient's policy number?
[CUSTOMER][POSITIVE] Oh yes, let me take a look into this one.
[CUSTOMER][POSITIVE] OK, uh thank you for patiently waiting there.
[CUSTOMER][NEUTRAL] Uh, I have the claim number and the policy number with me. So the policy number is 02278.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 199.
[AGENT][POSITIVE] Thank you for that. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] It's [PII] direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] uh sorry, it's [PII]
[CUSTOMER][NEUTRAL] And you put for [PII] is going to be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and data service.
[CUSTOMER][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] Bills amount.
[CUSTOMER][NEUTRAL] OK, the bill amount I have for this claim is going to be $3,428 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] This claim, it looks like was denied as a duplicate claim. There was a previous claim, it looks like submitted.
[AGENT][NEUTRAL] And that was already processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, thank you for the clarification, but as I'm looking here we have only received the EOB which was
[CUSTOMER][NEUTRAL] Uh, denied as a duplicate the claim which was denied as a duplicate. So I want to discuss that, uh, do you have any original claim number for me?
[AGENT][NEUTRAL] Uh, for the other claim?
[CUSTOMER][NEUTRAL] Oh, give me a second.
[AGENT][NEUTRAL] The denied claim is claim number 345-0284.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes, you're right, but as I'm looking here, I have the UB which states that the above reference claim appears to be a duplicate of previously submitted expense.
[CUSTOMER][NEUTRAL] So can you please provide me with the original EOB on my fax number?
[CUSTOMER][NEUTRAL] And uh please help me with the claim number. Uh, you told me the claim number and the date when you received the original claim and how much amount was paid.
[AGENT][NEUTRAL] Uh, just one moment, please. Let me take a look at this.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] So I don't have an explanation of benefits that I'm able to send you or provide. The claim was submitted by the insured and so for that reason, I'm not permitted to release any details.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can you please confirm whether the patient maximum uh patient policy benefits have been exhausted or not?
[AGENT][NEUTRAL] Uh, let me take a look one moment.
[AGENT][NEUTRAL] Uh, the patient outpatient benefit max is based off of a calendar day, and that is $500 for date of service [PII], that amount has been exhausted.
[CUSTOMER][NEUTRAL] Oh, I got it.
[CUSTOMER][NEUTRAL] OK, thank you. Can I get, can I get your name and the call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Call reference is going to be my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, sir. That's all for today.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] Could do.
[AGENT][NEUTRAL] Bye bye