AccountId: 011433970860
ContactId: b2f534f3-d697-49cd-a5bd-c1e3d0a59d3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 491619 ms
Total Talk Time (AGENT): 180517 ms
Total Talk Time (CUSTOMER): 190374 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/b2f534f3-d697-49cd-a5bd-c1e3d0a59d3f_20250123T14:48_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] Oh yeah, hi [PII]. This is, uh, [PII] calling you from provider office, which is, uh, [PII] for the specific question regarding the claim. So may I know the initial of your last name please?
[AGENT][NEUTRAL] It's [PII].
[AGENT][POSITIVE] And [PII], it would be my pleasure to help you with that claim information. What is a good callback number?
[CUSTOMER][POSITIVE] Yeah, thank you very much.
[CUSTOMER][NEUTRAL] Oh yeah, sure, so like one second, I'm just providing you that.
[CUSTOMER][NEUTRAL] So the callback number we have is uh [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And do you have that claim number available?
[CUSTOMER][NEUTRAL] OK, so the claim number.
[CUSTOMER][NEUTRAL] Regarding this one is, yeah, I got it. So it is uh 3507966.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] Name I have here is [PII] and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEGATIVE] No, sorry, it is no, no, no, no, sorry.
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] All right, thank you. You were giving me that data service, weren't you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So for that
[AGENT][NEUTRAL] Not a problem at all. So, on that claim number that you gave me, I show that that was denied as a duplicate.
[AGENT][NEUTRAL] I'm trying to get that original claim for you, bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5.
[AGENT][NEUTRAL] And that's Kaiser Foundation Hospitals.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so I did locate the original claim.
[AGENT][NEUTRAL] And I can give you that original claim information.
[AGENT][NEUTRAL] If you would like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, please, go ahead.
[AGENT][POSITIVE] All right, it'd be my pleasure. Now, the original claim.
[AGENT][NEUTRAL] We received, let me get that received date for you.
[AGENT][NEUTRAL] Original claim was received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] Now this claim was denied.
[AGENT][NEUTRAL] And the denial reason on this claim.
[AGENT][NEUTRAL] Was our records indicate that premium for this state of service was not received. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] I see due to that.
[AGENT][NEUTRAL] And I can provide
[CUSTOMER][NEUTRAL] Data services not payable, right?
[AGENT][NEUTRAL] That's correct. The patient was not eligible for benefits for that specific data service.
[CUSTOMER][NEUTRAL] OK. And so, could you please provide me the
[CUSTOMER][NEUTRAL] Eligibility for this mem member.
[AGENT][NEUTRAL] So the policy
[CUSTOMER][NEUTRAL] Effective and termination date.
[AGENT][NEUTRAL] Sure, [PII]. The effective date is [PII]. Now the policy turned on I'm sorry, [PII].
[AGENT][NEUTRAL] But even though the policy was.
[CUSTOMER][NEUTRAL] OK, so it's.
[AGENT][NEGATIVE] Um, turned on [PII], we did not receive that premium for that specific data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So this is the reason why it is, it got denied. So have you uh sent a letter to the patient regarding it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They received the same EOB that you receive.
[CUSTOMER][NEUTRAL] OK. Uh, when it was sent to the patient?
[AGENT][NEUTRAL] That was sent on [PII].
[CUSTOMER][NEUTRAL] So it was sent [PII].
[CUSTOMER][NEUTRAL] Send to patient.
[CUSTOMER][NEUTRAL] On dated [PII], but it is not updated yet, right?
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Mhm. OK. And could you please provide me the claim number regarding this?
[AGENT][NEUTRAL] Yes, sir, the original claim number is 350.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] 32
[CUSTOMER][NEUTRAL] So it is 350-0032.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So, and when did you receive the duplicate claim?
[AGENT][NEUTRAL] The duplicate claim was received on, let me get that for you.
[AGENT][NEUTRAL] On [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] 924, 924 2024.
[AGENT][NEUTRAL] 920, 2024.
[CUSTOMER][NEUTRAL] OK, my bad.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] Duplicate claim was received [PII] and the processed on [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And denied on the same date, uh, on [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Process and deny. Yeah, uh for the duplicate.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] Could you please provide me the call reference number for this?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[AGENT][NEUTRAL] Do you need me to spell my name? Yeah.
[CUSTOMER][NEUTRAL] OK. Your name, [PII], and 2 days. I got it.
[AGENT][POSITIVE] All right. Thank you, [PII].
[CUSTOMER][NEUTRAL] [PII] and
[AGENT][NEUTRAL] And it was a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It's been a pleasure to assist you with that claim information. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, I have like multiple I'm just looking for the another member.
[CUSTOMER][NEUTRAL] OK, I'm just providing you the next patient details. I have another patient to look up as well.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And is it, do you have the claim number or policy number?
[CUSTOMER][NEUTRAL] OK. I have the policy number which is X as in X-ray.
[CUSTOMER][NEUTRAL] 5288541.
[AGENT][NEUTRAL] That is not the APL policy number.
[CUSTOMER][NEUTRAL] OK. And what is the like uh identification for this APL?
[AGENT][NEUTRAL] So our policy numbers are
[AGENT][NEGATIVE] 7 digits long and normally start with a 0, no letters.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][NEUTRAL] Then I think I'm left with no other.
[CUSTOMER][NEUTRAL] Claims for the day now.
[CUSTOMER][POSITIVE] So thank you very much for your kind assistance on this. Thank you.
[AGENT][NEUTRAL] Well,
[AGENT][POSITIVE] My pleasure to assist you with that claim information, [PII]. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.