AccountId: 011433970860
ContactId: 955c8917-75d6-4b7d-9e98-228132a8af52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325529 ms
Total Talk Time (AGENT): 144302 ms
Total Talk Time (CUSTOMER): 148964 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/955c8917-75d6-4b7d-9e98-228132a8af52_20250115T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] and I'm calling you from the provider office. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking. Do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII].
[AGENT][POSITIVE] Thank you, so what is a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII] and it's a direct line and there is no extension.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes. Policy number is 02103258 M as in Mike, L for Lima, and the number 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Uh yes, first name is uh [PII]. with the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. Absolutely it will be my pleasure to assist you today with the policy for [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Actually, we have received the UV and in the UV it is mentioned that uh it is a duplicate claim and the previously it is paid. So I just want to check what is the status of the original claim.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Because we only received the duplicate UV but we have not received the original claim UV.
[AGENT][NEUTRAL] OK, thank you and do you have the claim number for the duplicate?
[CUSTOMER][NEUTRAL] Uh yes, let me check. Just give me a minute, OK? I have to open from the different system.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] No problem, just give me a minute.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just hold the line while I'm trying to find out.
[AGENT][POSITIVE] You're fine. Take your time.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] You want claim number, right?
[AGENT][NEUTRAL] If you have that available or the data service.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Uh yes. Claim, sir, uh claim number is 3482341.
[AGENT][NEUTRAL] Alright, thank you, and this is for data service 4024?
[CUSTOMER][NEUTRAL] Let me check. Uh, yes, 0409 uh 2024 and the date range is [PII].
[AGENT][NEUTRAL] West Boca Medical Center.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Is it for West Boca Medical Center?
[CUSTOMER][NEUTRAL] Uh, yes, exactly. Just book a Medical center.
[AGENT][NEUTRAL] All right, I can help you with that original claim number. We received the original claim on 6-11-2024.
[AGENT][NEUTRAL] Claim was processed and paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I can provide the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, uh, just a minute, OK?
[AGENT][POSITIVE] You take your time.
[CUSTOMER][NEUTRAL] 00, OK, just a minute, uh.
[CUSTOMER][NEUTRAL] Uh yes, what is the claim number?
[AGENT][NEUTRAL] The claim number is 349. I'm sorry, let me try that again 346.
[AGENT][NEUTRAL] 9475.
[CUSTOMER][NEUTRAL] OK. And what is the allowed amount? No problem. And what is the allowed amount on the paid amount?
[AGENT][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] And there's no contractual involvement in the processing of our claim. This is a secondary policy, and we paid $3000 to Westpon Medical Center.
[CUSTOMER][NEUTRAL] OK. And the last thing is that uh can you just confirm me the, uh, what is the appeal mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. I have one request. Uh, this claim is underpaid, uh, as per our uh contracted rate. So can you send this claim back for the reprocess?
[AGENT][NEUTRAL] No actually it is not underpaid. We paid the maximum benefit payable for inpatient hospital stay, the policy provides a $3000 per calendar year benefit. So with the payment of that claim it maxed out the benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you said the [PII] in after that.
[AGENT][NEUTRAL] then the state is [PII].
[CUSTOMER][NEUTRAL] OK. OK, right. OK.
[AGENT][NEUTRAL] That's correct. Zip code is [PII].
[CUSTOMER][NEUTRAL] What is going to be the zip code?
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK. And uh may I know your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII], just help me with the call reference number, please.
[AGENT][POSITIVE] The reference number is my name and today's date, and it has been a pleasure to help you with that claim status. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, at least.
[CUSTOMER][POSITIVE] No problem. So, uh, thank you, [PII], and take care. Stay safe and enjoy your rest of your day. Bye-bye.
[AGENT][POSITIVE] I hope you do too so thank you for calling APL. Take care.