AccountId: 011433970860
ContactId: b97da775-7aab-4350-aa56-9c2f55d2130c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678049 ms
Total Talk Time (AGENT): 114238 ms
Total Talk Time (CUSTOMER): 133979 ms
Interruptions: 4
Overall Sentiment: AGENT=1.7, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/b97da775-7aab-4350-aa56-9c2f55d2130c_20250109T21:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, my name is [PII]. I'm calling with Gastro Med LLC, and we had sent a corrected explanation of benefits.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, for a patient and, uh, we just got an explanation of benefits back indicating that it was a duplicate of a claim previously considered.
[AGENT][NEUTRAL] OK. Um, what is the policy number? Let me look at that.
[CUSTOMER][NEUTRAL] Thank you. Policy number is 02317864.
[AGENT][NEUTRAL] OK. And let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Yes ma'am, that is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And one
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] All right. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And what is the date of service?
[CUSTOMER][NEUTRAL] Data service was [PII] for $1350.
[AGENT][NEUTRAL] OK, um let's see.
[AGENT][NEUTRAL] OK, let me pull both of them and see what's the difference and see why they denied that that certificate. Do you mind holding for me?
[CUSTOMER][POSITIVE] No, not at all thank you so.
[AGENT][POSITIVE] OK, thank you. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] No problem, thank you.
[AGENT][NEUTRAL] Miss [PII], OK, you're welcome. Um, OK, so I went ahead and, uh, look into the two claims, and they look the same exact claim, um, 6982 was applied towards the member.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah, the right, the claim is this right, the claim is the same, um, they indicated that the explanation of benefits that we had submitted didn't show the information that they needed, which is why we send it a corrected explanation of benefits.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that was faxed on let's see here.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, 222, we faxed it on the [PII].
[AGENT][NEUTRAL] Oh, I see what happened.
[AGENT][NEUTRAL] On the [PII] we process this other claim, so it looks like we received it 3 times. Um, so we received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] we received two of them. We received one which we process a duplicate and then we received another one which we process and pay. So the one that we paid it should be on the way, uh, the check should be on the way, but yeah, we did process that one as well. So yeah, you're, you're gonna be receiving the denial and then yeah, that's where I was confused too.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] Oh, OK. I was, no, no, I, it's alright. That's why I went to call for I'm like, oh wait, and now I'm confused. OK, so the claim was processed for payment on the same day or give or take. OK, is there a claim number or?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh-huh, right, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, mhm, yes, the claim number is 3544552.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 354-455-52
[AGENT][NEUTRAL] Yes, and that's the one that is with the payment with the check. Mhm.
[CUSTOMER][NEUTRAL] OK, alright and the paid amount?
[AGENT][NEUTRAL] The the amount that it was owed the 69.82.
[CUSTOMER][POSITIVE] 6982. All right, perfect, thank you very much so I appreciate uh you for clarifying that for me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] No problem. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] And, and, and technically, I just, I just let you, I just made you, you know, use your brain, so you're welcome, see.
[AGENT][POSITIVE] Yeah, that's a good thing
[CUSTOMER][POSITIVE] All right, thank you very much I appreciate that information you too bye bye.
[AGENT][POSITIVE] All right, well, have a good afternoon. You're welcome, Miss [PII]. Bye-bye.