AccountId: 011433970860
ContactId: 8b2dfc19-dab5-41e5-a8b9-7a3db7ec2e31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452279 ms
Total Talk Time (AGENT): 168824 ms
Total Talk Time (CUSTOMER): 158429 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/8b2dfc19-dab5-41e5-a8b9-7a3db7ec2e31_20250326T13:13_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 [PII], my name is [PII], and I'm calling on behalf of provider's office to check on the claim status. Could you please help me with that?
[AGENT][NEUTRAL] OK, you said your name
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] It's [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], and you're needing claim status, is that correct? Yes, I can help you.
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] Yes, I can help you with claim status. And what is your callback number?
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] It's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And [PII], do you only have one claim to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. OK, what is that policy number, please?
[CUSTOMER][NEUTRAL] It is 02486619 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide for you today [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It was on [PII]. The total bill amount was $9,846 even.
[AGENT][NEUTRAL] OK, [PII] for $9,846. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this was received on [PII]?
[AGENT][NEUTRAL] Processed
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3546718.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] The reason for the denial?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] States the
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The above referent claim reference claim appears to be a duplicate of previously.
[AGENT][NEUTRAL] Submitted expenses.
[AGENT][NEUTRAL] Benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] Um, so, uh, you, uh, uh, the, the denial is a duplicate claim form, is that correct?
[AGENT][NEUTRAL] That is correct and benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Could you please uh verify it because we have submitted the claim earlier on
[CUSTOMER][NEUTRAL] Uh, [PII], uh, as an outpatient claim, and for the second time, we have submitted the claim as corrected claim dated [PII].
[AGENT][NEUTRAL] Yes, sir, that is the information. However, in the meantime, there was a claim received in which benefits were paid directly to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Could you please provide me the status of the original claim then?
[AGENT][NEGATIVE] It was denied for needing the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh could you uh please provide me the uh have you received the ERB?
[AGENT][NEGATIVE] Again, once we received it, it was denied as a duplicate because benefits were paid to the insured.
[AGENT][NEUTRAL] That is the
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Provided for you.
[CUSTOMER][NEUTRAL] OK. So the EOB was uh already received with the credit claim. Uh, but within that, uh, the benefits are paid to insure. Is that correct?
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it, thank you.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with those remarks, you can print that Anna by going to our portal and our website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, uh, with the, um.
[CUSTOMER][NEUTRAL] Denied a claim that is the uh duplicate claim. Uh, could you please provide me the uh original claim number?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The one that was denied needing an EOB?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 352-687-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it. OK. And the other claim number you have provided me already for the duplicate claim number. And uh could you please, mhm thank you. And could you please mention are there any procedure codes uh that need to be um
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] No, ma'am. There is, uh, there are no denial codes for that.
[AGENT][NEUTRAL] Uh, the only denial remark is the one that I read you.
[CUSTOMER][POSITIVE] OK. Thank you so much, uh, [PII] for the information. Could you please provide?
[AGENT][POSITIVE] You're very welcome and.
[CUSTOMER][NEUTRAL] And could you please provide me the call reference number?
[AGENT][NEUTRAL] Yes ma'am, the uh the call reference number would be my name.
[AGENT][NEUTRAL] And what's today's date?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] My name and today's date. Oh, you're very welcome. Well, yes, ma'am, you do. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] And you have a great day.
[CUSTOMER][POSITIVE] No, thank you so much you have a great day bye bye.
[AGENT][POSITIVE] OK. I hope you have a great day too, and thank you again for calling [PII].