AccountId: 011433970860
ContactId: b7745031-b7ed-4d6b-b101-f7bcfbc8ca87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316070 ms
Total Talk Time (AGENT): 127112 ms
Total Talk Time (CUSTOMER): 75584 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/b7745031-b7ed-4d6b-b101-f7bcfbc8ca87_20250528T13:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] This is [PII] calling the office. Check on the claim status.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] I can, I can hear you now.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII]. I'm just looking for the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02569249
[AGENT][NEUTRAL] 692-49. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII] for $3,835.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim has been received more than once. The most recent received claim was denied as a duplicate of previously submitted expenses. Do you need the original claims information?
[CUSTOMER][NEUTRAL] One moment, ma'am. Uh, I just need the status for the claim ends with
[CUSTOMER][NEUTRAL] 5888.
[AGENT][NEUTRAL] Denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] Um, just for duplicate, OK. Um,
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What is the date and denied date?
[AGENT][NEUTRAL] For that claim number that was received on [PII] and processed and denied on [PII]?
[CUSTOMER][NEUTRAL] OK. And now, can I get the status for the original claim?
[AGENT][NEUTRAL] The original claim is 3,583,830. That claim was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] And that claim is denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am. Thank you. What is, uh, can I get your fax number?
[AGENT][NEUTRAL] The claims fax number is [PII]. Attention claims.
[AGENT][NEUTRAL] And if you need a copy of these explanation of benefits, [PII], with those remarks, you can print them from our portal by going to [PII].
[CUSTOMER][NEUTRAL] What is the time you?
[AGENT][NEGATIVE] And there is no timely filing for submitting this.
[CUSTOMER][NEUTRAL] OK. What is the timely filing for submitting the claim?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] I just gave that to you. There is no timely filing.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, ma'am. The initial claim is denied for primary UOP and the second claim is denied for two. That's right.
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][POSITIVE] Thank you, ma'am. Can you spell out your name?
[AGENT][NEUTRAL] [PII], and my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Thank you. Thank you so much, ma'am.
[AGENT][POSITIVE] You're welcome. Yes, sir. You're very welcome. And is there anything else [PII] I can help you with?
[CUSTOMER][NEUTRAL] Nothing, ma'am. Nothing else.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.