AccountId: 011433970860
ContactId: 90b5c364-7678-4adb-a37a-b6d0b7b98da5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631469 ms
Total Talk Time (AGENT): 195663 ms
Total Talk Time (CUSTOMER): 102167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/90b5c364-7678-4adb-a37a-b6d0b7b98da5_20250102T14:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I want to check on claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with claims, and can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 02301362.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] And thank you so much for holding [PII]. I apologize for that wait. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's first and last name is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] 2024 and total charge is $3,795 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] No, it's Louisiana Endoscopy Center.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is this for a facility charge or is there diagnosis codes on, I'm sorry, procedure codes?
[CUSTOMER][NEUTRAL] Proceed the record.
[AGENT][NEUTRAL] OK, what procedure codes are in your claim? We receive multiple for that day.
[CUSTOMER][NEUTRAL] It's 43248 4323945385.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] So we have claims that have your codes, but it's not the same total bill. Is there any other total bill that it can be?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, that is different bill amount.
[CUSTOMER][NEUTRAL] It is 1265.
[AGENT][NEUTRAL] OK, wait a minute. That's a different amount than I see too. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said 1265?
[AGENT][NEUTRAL] OK, I'm gonna have to search [PII]. Do you mind if I place you on just another brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] OK. Is this a duplicate?
[AGENT][NEUTRAL] So what is the dupe of?
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh, it's a dup because the insured. Wait a minute.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Oh, so they're just saying in that this charge was included. Is that right?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But I don't see that provider.
[AGENT][NEGATIVE] That's not right.
[AGENT][NEGATIVE] There is no, this isn't right.
[AGENT][NEUTRAL] Oh, wait.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] Mm that's gonna take a long time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. So I did figure out what happened. So it looks like the insured also um filed a claim and included this amount in the claim and the claim was paid out on. So I can't give the um claim information because it's the insured, but I do have the claim status for your claim. It was denied as a duplicate because the insured's claim came through first.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we received your claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 7094.
[AGENT][NEUTRAL] And on [PII], the claim was denied because it was a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And the benefit has been paid to the insured.
[CUSTOMER][NEUTRAL] So, the claim is paid to patient, the original claim?
[AGENT][NEUTRAL] Correct, the patient filed the claim back on [PII].
[AGENT][NEUTRAL] So that claim was processed before your claim came in.
[CUSTOMER][NEUTRAL] And can you let me know the claim number for that claim?
[AGENT][NEUTRAL] Unfortunately, I can't because it's the insured's claim. I can only give you your claim status for your provider claims. Um, however, you can reach out to the insured and um see what amount was paid and if it is to be paid to you, the insured would have to take care of that with you.
[CUSTOMER][NEUTRAL] OK, not a problem, [PII].
[CUSTOMER][POSITIVE] Great, can you give me call reference?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that's all for today. Thank you.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL and Happy New Year.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.