AccountId: 011433970860
ContactId: c779645a-8346-4962-917d-9b8ad747f0a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456170 ms
Total Talk Time (AGENT): 148306 ms
Total Talk Time (CUSTOMER): 144263 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/c779645a-8346-4962-917d-9b8ad747f0a5_20250623T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I have already checked DOB and have information. I don't claim denial. I'm calling for clarify. Yes, please.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, yes, I can get clarification regarding that claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Uh, policy number, you're asking for the member ID?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it is 247-492-4.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] DC on the on the.
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that uh and then do you have that claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Claim number, just a second. Give me 1 minute.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] The details are loading in my.
[AGENT][NEUTRAL] You're fine. Sure.
[CUSTOMER][NEUTRAL] And yes, I do have the claim number. It is 3608142.
[AGENT][NEUTRAL] 8142. OK, thank you one moment.
[CUSTOMER][POSITIVE] OK, take it on time.
[AGENT][NEUTRAL] OK, well this claim is stating that it is a duplicate so if you'll give me one moment, I will try to locate that original claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The date of service that was uh [PII].
[CUSTOMER][POSITIVE] They, yes, exactly.
[AGENT][NEUTRAL] OK, got it. Alrighty, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I do believe I found this original claim um bear with me just a moment to make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, um, so we did, uh, let me know when you're ready I'll go ahead and give you that original claim number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] That is 357-647-777.
[CUSTOMER][NEUTRAL] OK. It is 2546477.
[AGENT][NEUTRAL] 357-6477.
[CUSTOMER][NEUTRAL] 3576477. OK.
[AGENT][NEUTRAL] Correct, yes, OK, now for this claim we did pay a benefit of $75 and that was the maximum amount payable for this date of service.
[CUSTOMER][NEUTRAL] OK. So you're telling that the original claim got paid?
[AGENT][POSITIVE] Yes, that's correct. $75.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I do have that check number I can give you whenever you're ready.
[CUSTOMER][NEUTRAL] Give me one second while I cross-check in my end for the details.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yes, could you please provide me the check number?
[AGENT][NEUTRAL] Yes, that is 20.
[AGENT][NEUTRAL] 33
[AGENT][NEUTRAL] 428.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and I am showing, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You stated it, the pay, the pay amount is $75 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And download amount?
[AGENT][NEUTRAL] That was the maximum amount payable was the $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please provide me the PD?
[AGENT][NEUTRAL] Of course, so this check was issued on [PII], and I am showing it did clear [PII].
[CUSTOMER][POSITIVE] Cleared on [PII]. Thank you so much.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And is, you stated that it is paid by a check, am I right?
[AGENT][NEUTRAL] Yes, it's a single track.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is a single payment.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the single payment amount, single amount?
[AGENT][NEUTRAL] $75 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one minute. Let me check in my end for the details.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If you'd like I can send you a copy of this EOB excuse me.
[CUSTOMER][NEUTRAL] Um, that's OK.
[CUSTOMER][NEUTRAL] And could you please once verify the address?
[AGENT][NEUTRAL] Oh yes, one moment, let me get that.
[AGENT][NEUTRAL] OK, that check was sent to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And could you please verify the patient's account number? Is it 14,847,050 V as in Victor 1438?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII], was there anything else I could help you with?
[CUSTOMER][POSITIVE] That's all the information I need today. Thank you so much. Thank you for your assistance. Have a wonderful day.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.