AccountId: 011433970860
ContactId: ae3408e4-c886-42e3-82ad-58acfec2b2c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343880 ms
Total Talk Time (AGENT): 147388 ms
Total Talk Time (CUSTOMER): 82747 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/ae3408e4-c886-42e3-82ad-58acfec2b2c8_20250402T15:07_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, my name is [PII] calling from provider office. Can you please help me with the claim status?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status high. And how many claims do you have in total today?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] One client.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the um policy number?
[CUSTOMER][NEUTRAL] Well, it's
[CUSTOMER][NEUTRAL] 02496781.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient's name is [PII] and the 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. May I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yeah, the date of services.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $22,422.90 90.
[AGENT][NEUTRAL] Thank you. So I have [PII] $22,422.90.
[CUSTOMER][NEUTRAL] It's $22,422.90.
[AGENT][POSITIVE] Correct. OK, yes, that's correct. Thank you. Hold on one moment.
[AGENT][NEUTRAL] So we received this 3 times. Did you want the original or the the other 2 were denied as duplicates? Did you just want the original?
[CUSTOMER][NEUTRAL] Tell me the original bank status.
[AGENT][NEUTRAL] I'm sorry, you sound really far away. I couldn't hear you. Can you repeat that?
[CUSTOMER][NEUTRAL] Can you please tell me the original claim status?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] Alright, we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3.
[CUSTOMER][NEUTRAL] It's November [PII], right?
[AGENT][NEUTRAL] Yes, [PII], 13, 2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] The claim number is 353-0365.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the insured's primary insurance provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] Can you please repeat it again why the claim was denied?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, and the insured's primary insurance provided full benefits.
[AGENT][NEGATIVE] So there are no benefits payable.
[CUSTOMER][NEUTRAL] Actually, the primary insurance was paid $1,641.
[AGENT][NEUTRAL] OK, if you like, I can get, yes, I'm here if you like, I can get a member of the claims team on the line to explain further, um.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] So yes, we did receive the claim, but from the explanation of benefits we received, it's showing that primary paid everything, which is why the other two claims were denied as a duplicate.
[CUSTOMER][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] OK, can you send the primary OB now?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you send, can I send the primary will be now?
[AGENT][POSITIVE] Yes, you can. Yes, that's what we're requesting. You can if you have an explanation of benefits showing that primary has not paid everything, then yes, you can submit that explanation of benefits.
[CUSTOMER][NEUTRAL] OK, can you please tell me your fax number?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] How much is the time limit to send the document?
[AGENT][NEUTRAL] There's no timely filing as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you please spell your name once?
[AGENT][NEUTRAL] Sure, my name is [PII] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Can you please give me your call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for the information. Have a good day.
[AGENT][POSITIVE] You're welcome, Ty. You also, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great week.