AccountId: 011433970860
ContactId: 9f485e7f-a636-4044-a2f7-fd04c129f871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 612840 ms
Total Talk Time (AGENT): 181583 ms
Total Talk Time (CUSTOMER): 148921 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/9f485e7f-a636-4044-a2f7-fd04c129f871_20250320T20:38_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my good, sorry, sorry, sorry, uh, this is my calling from I got the claim status. How are you doing today?
[AGENT][NEUTRAL] I'm doing well. It's it's hard to hear you. I heard claim status, but I didn't hear anything else. Can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] OK. Hi, this is [PII] calling from IQI provider's office regards the claim status.
[AGENT][POSITIVE] OK, [PII], I'll be more than happy to help you with your claim status. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, the best contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the member's policy number is 02544969.
[AGENT][NEUTRAL] 02544969
[CUSTOMER][NEUTRAL] Yes, it's 02544969.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII] and the last name is [PII], and the member's date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Uh, yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $914 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, yes, one second.
[CUSTOMER][NEUTRAL] Yeah, the provider's office is aging LLC.
[AGENT][NEUTRAL] OK, hold on one moment there it is.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] The claim number is 35414.
[CUSTOMER][NEUTRAL] 354. Yes.
[AGENT][NEUTRAL] So 3541459?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It looks like the insured submitted that claim. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yep, sorry.
[AGENT][NEUTRAL] I'm sorry, I didn't hear what you said.
[CUSTOMER][NEUTRAL] No, uh, I did not hear you. Will you please repeat once again?
[AGENT][NEUTRAL] So I was asking if I can place you on a brief hold because it looks like the claim that I was giving you the insured submitted, the claim that we received from the provider, we received on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, no, actually the claim was red, I think so it was received on [PII].
[AGENT][NEUTRAL] These are all to the to the insured. I'm giving you the claim status for the provider.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] So we received the provider claim on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 354-7183.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Someone on January, January.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the claim was denied because it was a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Uh, I, um.
[CUSTOMER][NEUTRAL] It was uh duplicated with the CPD 77065.
[AGENT][NEUTRAL] Yes, so like, for example, the uh the original claim number that I gave you as well as the um
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] 354-717-6 number that you gave, those were.
[AGENT][NEUTRAL] These were all paid to the insured. The insured submitted though, so we can't give you that claim status, but it came in before yours, so it's a yours would be the duplicate of that claim, and it was paid to the insured.
[CUSTOMER][NEUTRAL] OK, it was OK, it was, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, if you don't mind, can I place your call on hold for a moment, please?
[AGENT][NEUTRAL] Of course, sure.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, thanks for the patience. You are waiting for the call. Yeah, uh, as I can, uh, you said that it was denied as a duplicate, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] But I, uh, as I can see that it was billed only once.
[AGENT][NEUTRAL] From the provider. The claim was also billed by the insured, so the insured filed the claim first, so yours is a duplicate of the first claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, as you said that it was built twice and one is from provider and another is from insurance, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, uh, one moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, thanks for your patience, and if you don't mind, can I have the, yeah, if you don't mind, can I have the call reference number for this?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last.
[CUSTOMER][NEUTRAL] Uh, will you please spell out your name?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] My name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and the state, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, thank you for assisting me. Have a nice day. Bye bye.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can assist with today?
[CUSTOMER][POSITIVE] Uh, no, no, thank you so much for your assistance.
[AGENT][POSITIVE] All right, thanks for calling APL. You're welcome.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] OK.