AccountId: 011433970860
ContactId: 90b557ee-1874-42ba-9a19-cec35c34c369
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451739 ms
Total Talk Time (AGENT): 140080 ms
Total Talk Time (CUSTOMER): 115478 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/90b557ee-1874-42ba-9a19-cec35c34c369_20250123T22:02_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I need to um get a claim status please.
[AGENT][POSITIVE] OK, I can help you with your name.
[CUSTOMER][NEUTRAL] A mandatory.
[AGENT][NEUTRAL] [PII], what's the policy number?
[CUSTOMER][NEUTRAL] 740.
[CUSTOMER][NEUTRAL] 240.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, for me, [PII] [PII].
[AGENT][NEUTRAL] Oh, OK, what's your date of birth and mailing address, [PII]?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Showing a [PII] account?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that for me and you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And what was the provider's name on the claim?
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Is it AdventHealth?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's processed in December. It says that the above referent claim claim appears to be a duplicate of a previously submitted claim. Give me a moment. Let me go back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think they're waiting for medical records.
[AGENT][NEUTRAL] Yeah, that was the first uh remark on the first claim that we received.
[AGENT][NEUTRAL] But then that 2nd time.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] One second.
[AGENT][NEUTRAL] Alright, so as of the [PII] we actually contacted um AdventHealth to follow up on the records.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Spoke with the medical records department that they stated they did not receive a request.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So we faxed the information again. Were there several other people involved in the accident?
[CUSTOMER][NEUTRAL] Um, that one was just for me.
[AGENT][NEUTRAL] OK, so that may be let's see.
[AGENT][NEUTRAL] Give me just a moment, OK? I'm gonna connect with that area with that team, hold on.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] Doing well [PII] thank you how are you?
[AGENT][NEUTRAL] Good. I have an insured on the phone. Um, it's regarding policy 740,240.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she's calling about a date of service up for her [PII].
[AGENT][NEUTRAL] So the latest one I found was 354-300-009.
[AGENT][NEGATIVE] It looks like we denied that as a.
[AGENT][NEUTRAL] Duplicate to a claim previously submitted.
[CUSTOMER][NEUTRAL] OK, 354-300-09?
[AGENT][NEUTRAL] Mhm. And so I found the other one under 353-633-5.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's the one that we cited that we're requesting medical records.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I see that uh huh so we're probably waiting for the medical records, um, I believe [PII] is handling.
[CUSTOMER][NEUTRAL] These claims, um, they'll be, I mean I can try to let her know that that's what's going on. So yeah, it looks like it was denied a duplicate because it's pending for the medical records. I would assume, yeah.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so the insured sending the same bill. Is that what it is? Is that why it's denying as a duplicate?
[CUSTOMER][NEUTRAL] Um, probably I mean I'd have to pull the image up to look at that, but that's more than likely if it was denied as duplicate, that's usually why? because we already have that claim on file and so we might be waiting obviously in this particular case we're waiting for those medical records, but I could pull it up and take a look. I mean, did you need me to talk to her?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you don't mind, um, I don't know when we initially requested the records. Do we do like follow ups or something about the records if we don't get them at a certain time or no?
[CUSTOMER][NEUTRAL] Um, I believe we're supposed to, yes, but, um, like I said, I know these are being handled by [PII], so.
[AGENT][NEUTRAL] OK. If, if you don't.
[AGENT][NEUTRAL] Yeah, if you don't mind um intercepting the call.
[CUSTOMER][NEUTRAL] OK, and she's been verified?
[AGENT][NEUTRAL] She's been verified, yeah.
[CUSTOMER][NEUTRAL] And that's all her information there, uh, I'm sorry, her phone number, yeah, mhm.
[AGENT][NEUTRAL] The phone number, the phone number. Yes, it is.
[CUSTOMER][POSITIVE] Alright, great.
[AGENT][POSITIVE] All right. Thank you, [PII].
[CUSTOMER][POSITIVE] Sure, I'm gonna pull up those records now thank you.
[AGENT][POSITIVE] OK. You're welcome, and here she comes.
[CUSTOMER][NEUTRAL] OK