AccountId: 011433970860
ContactId: aea23dd8-a653-4307-86a0-01f8d07d0705
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1242540 ms
Total Talk Time (AGENT): 327294 ms
Total Talk Time (CUSTOMER): 342956 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/aea23dd8-a653-4307-86a0-01f8d07d0705_20250613T20:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider office. I'm looking for a status. Hi, how are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yes, it's doing well. Actually, I'm looking for a status. Please kindly look into this.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] And may I have your name, please?
[CUSTOMER][NEUTRAL] Sorry, may I have your name please, first for the notation part?
[AGENT][NEUTRAL] My name is [PII], and that is spelled [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] PE sorry, what's the, again?
[AGENT][NEUTRAL] It is [PII] and today's date is the call reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, so the policy number is 01868895.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] But um
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] And may I have the service and total bill that you're calling in for?
[CUSTOMER][NEUTRAL] Sure, you repeat again.
[AGENT][NEUTRAL] The date of service and total bill.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII]. And the total charge amount was 128660.20.
[CUSTOMER][NEUTRAL] And we have
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Appeal on appeal on this appeal, [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, I'm here. I'm pulling the information up for you now.
[CUSTOMER][NEUTRAL] OK, OK. OK, go, go ahead.
[AGENT][NEUTRAL] And this is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, because I'm not seeing a claim on file for that date of service.
[AGENT][NEUTRAL] And that is for data service of 76 of 23 to 170 of 23?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] No claim is on file.
[AGENT][NEUTRAL] For that data service for this member.
[CUSTOMER][NEUTRAL] No, actually, could you check as well from the claim number? I have a claim number.
[AGENT][NEUTRAL] May I have that please?
[CUSTOMER][NEUTRAL] 333-926
[AGENT][NEUTRAL] That is 333-926.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, that's not enough numbers for one of our claim numbers.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] I will check again.
[CUSTOMER][NEUTRAL] Give me a moment, please.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Give me just, give me a sec.
[CUSTOMER][NEUTRAL] With this what the help when that is.
[CUSTOMER][NEUTRAL] OK, I have a claim number is 3368809. Could you check?
[AGENT][NEUTRAL] 336-8809
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, you said that this claim is for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Actually, the BCBS crossover claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You're looking for the last appeal status which has
[CUSTOMER][NEUTRAL] Sand on.
[AGENT][NEUTRAL] OK. So you will have to give me the mem the patient's name and their date of birth, and then I will be able to pull that information up and be able to give that to you.
[CUSTOMER][NEUTRAL] Give me a moment. It's a this a
[CUSTOMER][NEUTRAL] Yes, please. The patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] That is not the patient name for that date of service in this claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, give me a moment. Just, uh, it's loading again, it's so different.
[CUSTOMER][NEUTRAL] Uh, we
[CUSTOMER][NEUTRAL] Because of I have the claim number as well. I have the recently to an appeal a letter which has
[CUSTOMER][NEGATIVE] Let me check. It's already already sent and exhausted.
[CUSTOMER][NEUTRAL] Please stay on line.
[CUSTOMER][NEUTRAL] Yes, yes, the name is actually.
[CUSTOMER][NEUTRAL] The memories is all dies, right? It's uh in your name. I just called, I just tell.
[CUSTOMER][NEUTRAL] I just told [PII]. It is the insured name and the patient name is is well dies with his date of birth. Uh.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] OK, so for that claim it shows that it processed and paid with a different claim number and the benefit max was met so any other claim that claimed that came in, it is showing that it did not as a duplicate because the claim has already been processed and paid.
[CUSTOMER][NEUTRAL] You are saying that it was already paid and paid for the patient, right?
[AGENT][NEUTRAL] Yes, as you stated, the maximum amount was already paid. So this claim has already previously been paid before and the maximum has been met.
[CUSTOMER][NEUTRAL] And I have the claim number is 3, no.
[CUSTOMER][NEUTRAL] No, actually, I have the claim number which is 333926 and we had sent an appeal particular in this claim.
[AGENT][NEUTRAL] So that claim number
[CUSTOMER][NEUTRAL] And we are looking for the last appeal status.
[AGENT][NEUTRAL] And they denied as a duplicate because that claim number that you just gave me has already paid the maximum amount. So any other claim that came in, it did not as a due because we've already paid the claim.
[CUSTOMER][NEUTRAL] Which is
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No, actually, I, I, I'm just, yea[PII], I got your point.
[CUSTOMER][POSITIVE] I call it the point please actually.
[CUSTOMER][NEUTRAL] Uh, we had sent on appeal. So we are looking for the appeal status. When did you receive a pill? For [PII], which is sent. So could you check, please?
[CUSTOMER][NEUTRAL] What is the reason?
[AGENT][NEUTRAL] Let me see when is the latest, when it's the latest that we received it.
[CUSTOMER][NEUTRAL] Yes, please, go ahead.
[AGENT][NEUTRAL] So the last time that it is showing that we received a claim for that date of service was [PII] and that claim denied as a duplicate because it has already been paid and processed.
[CUSTOMER][NEUTRAL] No, actually, we had sent on appeal first. Oh sorry, we are looking for the appeal status. Are you able to see for the date of uh appeal?
[AGENT][NEUTRAL] The latest that we received, as I previously stated, was [PII].
[AGENT][NEUTRAL] We have no other doctor.
[CUSTOMER][NEUTRAL] No, actually, uh, we had sent.
[CUSTOMER][NEUTRAL] No, actually, we have sent appeal on [PII]. We are looking for the appeal status for the state of. Could you check?
[AGENT][NEUTRAL] And as I advised you, the last, the last claim that we received was 1017 of 23. We have no other claim that has been received.
[CUSTOMER][NEUTRAL] When what?
[CUSTOMER][NEUTRAL] No, uh, no, no, I'm looking for the claim. I'm just looking for appeal status.
[AGENT][NEUTRAL] That will be known as a claim, sir.
[CUSTOMER][NEUTRAL] Oh yeah, you're saying that they're known as a claim, right?
[AGENT][NEUTRAL] Once we receive the documentation, if we process it, that is a claim because the claim number is given. So that claim, the last one we received was 1017 of 23. There's no other claim after that or appeal or anything that has been received for that date of service.
[CUSTOMER][NEUTRAL] So when did you receive the test?
[CUSTOMER][NEUTRAL] So what is the last appeal status, claim status, right?
[AGENT][NEGATIVE] This would be my last time giving you this information. It denied as a duplicate.
[CUSTOMER][NEUTRAL] Please tell me once.
[CUSTOMER][NEUTRAL] And duplicate, what is that, uh, duplicate claim number?
[CUSTOMER][NEUTRAL] What is the original claim status?
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] That is that what are you asking?
[CUSTOMER][NEUTRAL] No, you are saying that it is denied duplicate, right? What is the original uh status? Original claim?
[AGENT][NEUTRAL] That original claim number is the one that you're giving me, which is 333-9261. That claim processed and it made a payment of $2550. Once that payment was paid, that was the maximum amount that we could pay out.
[CUSTOMER][NEUTRAL] When was it?
[CUSTOMER][NEUTRAL] No, actually, what is the paid amount and when was processed, please once?
[AGENT][NEUTRAL] So you needed me to give you the same information on the number that you already given me?
[CUSTOMER][NEUTRAL] Repeat again.
[CUSTOMER][NEUTRAL] You are saying that it was the claim number 39926. It is already paid and processed correctly, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEGATIVE] And it looked like we received several claims after that, but the last one that I gave you was at 336-880-9, and that's the recent one, and it denied as a dupe.
[AGENT][NEUTRAL] And any other claim after the first one that has been paid, they're all going to deny because it has already been processed.
[CUSTOMER][NEUTRAL] TP yeah.
[CUSTOMER][NEUTRAL] What is the duplicate number, please? Claim number?
[AGENT][NEUTRAL] For which one?
[CUSTOMER][NEUTRAL] Repeat again.
[CUSTOMER][NEUTRAL] Duplicate you provided me just.
[AGENT][NEUTRAL] OK, [PII], I've, I told you that that was gonna be my last time giving you that claim number and the denial. So I've already given you that claim number 4 times.
[CUSTOMER][NEUTRAL] You provided me only uh the original claim number which is 339261. It is paid to process correctly, right?
[AGENT][NEUTRAL] No, that's not. OK, [PII], this will be my last time giving you this claim number and I will not repeat it. I gave you 336-8809 which was received in [PII]. That's the information that I gave you, [PII].
[CUSTOMER][NEUTRAL] OK. It is a duplicate under and we have original claim was 339261, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So for that we can send any appeal.
[AGENT][NEGATIVE] We have received 4 appeals, and they all denied as dupes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, are you able to fax the last appeal which has already denied?
[AGENT][NEUTRAL] OK, so with that claim number is the one that you originally gave me, so I believe you already have that.
[AGENT][NEUTRAL] EOB
[AGENT][NEUTRAL] Because that's the same claim number that you gave me during the call.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So what other documentation are you needing since you already have the EOB for that claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for that, no need to uh send any appeal, right?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Actually, for no need to send any appeal.
[CUSTOMER][NEUTRAL] As for the previous claim was paid and processed correctly.
[AGENT][NEUTRAL] You can submit as many appeals as you want, but they're still going to deny because that claim has already been paid.
[AGENT][POSITIVE] The member has no other amount that could beat it out.
[CUSTOMER][NEUTRAL] How much paid amount uh once you verify?
[AGENT][NEUTRAL] So you're needing the payment amount again?
[CUSTOMER][NEUTRAL] Right. It was 2550, right?
[AGENT][NEUTRAL] That is correct, and that's the maximum amount once that was paid.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] No, I, thank you. What's the call reference number?
[AGENT][NEUTRAL] As I stated at the beginning of the call, it is first name, last initial, and today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Have a nice day. Bye for now. Happy weekend.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome thank you for calling American Public Life. Have a great day as well.