AccountId: 011433970860
ContactId: b1bcdc32-45e1-4421-a0d3-4d716fb4ab27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357269 ms
Total Talk Time (AGENT): 142450 ms
Total Talk Time (CUSTOMER): 101136 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/b1bcdc32-45e1-4421-a0d3-4d716fb4ab27_20250421T14:27_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 calling from 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, and did you say your name was [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, and so, may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, 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 member's name is uh [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [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 and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII]. And the total charges is $19,584.90.
[AGENT][NEUTRAL] $19,584.90.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so we've received this 4 times. Let me see, are you calling for the original or one of the duplicates?
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, actually, we have received the, it will be on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it shows that uh it is a duplicate claim service. Can you please help me with the personal claim status?
[AGENT][NEUTRAL] Yes, on [PII], we received the claim.
[AGENT][NEUTRAL] It's um claim number 353-0365.
[AGENT][NEUTRAL] And on November
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On [PII], the claim was denied because the insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK. The claim was denied because of primary insurance, right?
[AGENT][NEGATIVE] Right, it was denied because primary insurance.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here. Give me just a moment. So it was denied because primary insurance paid the um provided full benefits, paid the balance. There's nothing left to pay.
[CUSTOMER][NEUTRAL] OK, just give me, um.
[CUSTOMER][NEUTRAL] OK, actually.
[CUSTOMER][NEUTRAL] OK. Uh, can I send the primary will be?
[AGENT][NEUTRAL] Um, if you have a copy showing that they have that they have, um, paid or that they have not paid the full balance, yes, you can send it. Um, this claim has been resubmitted 3 other times, but they were all denied as duplicate. Do you have an explanation of benefits showing that primary did not pay the full balance?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK. Uh well, sure, you can um submit that and we'll definitely um process it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the claim date is [PII], right?
[AGENT][NEUTRAL] That was the date that we risk.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Ma'am, I'm here. I'm, I just need a minute to look for what you're asking me. So you asked me for [PII] as to what date?
[CUSTOMER][NEUTRAL] What is the claim reserved date?
[AGENT][NEUTRAL] OK, hold on one moment, let me go back.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] The original claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please give me your fax number?
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can you please spell your name once?
[AGENT][NEUTRAL] My name is [PII] The first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] So, can you please give me a call reference number of this time?
[AGENT][NEUTRAL] Again, there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for the information. Have a good day.
[AGENT][POSITIVE] Thank you, sir. You also, and thanks for calling APL. Bye-bye.