AccountId: 011433970860
ContactId: d2f75b24-62b5-4e2e-a0d6-49e923a2b557
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674159 ms
Total Talk Time (AGENT): 180406 ms
Total Talk Time (CUSTOMER): 210920 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/d2f75b24-62b5-4e2e-a0d6-49e923a2b557_20250407T18:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check on claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm also good. Thank you for asking.
[AGENT][NEUTRAL] You're welcome, and may I please have the call back number?
[CUSTOMER][NEUTRAL] OK, sure. Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I please have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh 183.
[CUSTOMER][NEUTRAL] 892
[CUSTOMER][NEUTRAL] And the 9.
[AGENT][NEUTRAL] 1838929
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. It's a patient's name is [PII]. And date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for status. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, OK. It's uh date of service is uh [PII], 202023.
[AGENT][NEUTRAL] 622 of 23.
[CUSTOMER][NEUTRAL] Yeah, 622-2023.
[AGENT][NEUTRAL] And may I have the date, the total bill?
[CUSTOMER][NEUTRAL] Yeah, it's OK. Uh, bill amount is $339 even.
[AGENT][POSITIVE] Thank you, and you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK. Uh, so, could you please provide the claim status?
[AGENT][POSITIVE] Yes, I'm pulling the information up for you now.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And for that claim, it does show that we received it in twice and both denied that office visit procedures are not covered. Let me get you the receipt date and the denial date.
[CUSTOMER][NEUTRAL] OK. When it is received?
[AGENT][NEUTRAL] I'm pulling that up for you now. I'm getting the receipt date and the denial date for you.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] So for the first claim, it shows that we received it on [PII].
[AGENT][NEUTRAL] It was processed on [PII], and as I stated, it did deny that office visits and office procedures are not covered.
[AGENT][NEUTRAL] And for that claim number it is 334.
[AGENT][NEUTRAL] 7967.
[AGENT][NEUTRAL] Then we received it again on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 357-871-5. That one also shows that it denied as office procedures are not covered, which would be a duplicate claim.
[CUSTOMER][NEUTRAL] Uh, sorry for that one. So, could you please, uh, tell slowly and, uh, repeat that one, please?
[AGENT][NEUTRAL] Repeat, which one?
[CUSTOMER][NEUTRAL] Uh, yeah, second client.
[AGENT][NEUTRAL] You need the 2nd claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim number again is 357.
[AGENT][NEUTRAL] 8715.
[CUSTOMER][NEUTRAL] OK. Uh, this one, when, when it is received under dinner?
[AGENT][NEGATIVE] It was received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, it's denied as duplicate, right?
[AGENT][NEUTRAL] It denied as office procedures are not covered, which is a duplicate claim of the previous submitted claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Uh just.
[CUSTOMER][NEUTRAL] OK. uh OK. Please hold for a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, hello. Uh, thank you so much for being on hold.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, uh, OK, wait, uh, it's dinner is duplicate. Um, um, may I know the reason why your office visits are not covered? Uh, I mean, uh, it's a provider plan or patient's plan?
[AGENT][NEUTRAL] This is the this is the patient's plan.
[CUSTOMER][NEUTRAL] OK, uh, patients, patients plan office visits are not covered, right?
[AGENT][NEUTRAL] Office procedures are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Office procedures.
[CUSTOMER][POSITIVE] OK. OK. Thank you, thank you so much. And uh
[CUSTOMER][NEUTRAL] OK. OK. Just a minute. What is the.
[CUSTOMER][NEUTRAL] Claim number.
[CUSTOMER][NEUTRAL] There is, OK. Uh, here, as I see in our records, uh, your claim number is uh different. Could you please check this claim number?
[AGENT][NEUTRAL] May I have the claim number please?
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, it's 202.
[CUSTOMER][NEUTRAL] 321
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] B as in beta.
[AGENT][NEUTRAL] That's not one of our claim numbers.
[AGENT][NEUTRAL] That's probably from the primary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I mean, uh, sir, I'm telling this is the claim num uh claim number.
[AGENT][NEUTRAL] Our claim numbers is what I gave you were those two claim numbers. Those are our claim numbers and they did not. That claim number that you're giving me is not one of our claim numbers.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Could you please check this claim is in progress or not?
[AGENT][NEUTRAL] I just advised you of the status of those claims for that date of service, that is not one of our claim numbers that you're giving me.
[CUSTOMER][NEUTRAL] OK, OK. OK. This is incorrect. OK. What you give, that is correct, right? Uh, uh, um.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] is the claim number.
[CUSTOMER][NEUTRAL] Uh, so, uh, sorry for asking this question and uh
[CUSTOMER][NEUTRAL] Uh, claim number, uh, uh, which one, which is the exact claim number, first one or second one?
[AGENT][NEUTRAL] Which one is what now?
[CUSTOMER][NEUTRAL] Uh, yeah, uh, this is, you give first one claim number is 3347967. And uh and the second one is 3578715.
[AGENT][NEUTRAL] Yes, we received two different claims in and they were processed, so those are the two claim numbers for those claims that was received.
[CUSTOMER][NEUTRAL] OK. 2 claims are billed with the same data and same bill amount, right?
[AGENT][NEUTRAL] Yes, the provider submitted it in twice.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Second one is 357-8715. OK. OK. OK, [PII], thank you so much for giving this information and uh could you please provide the call reference number?
[AGENT][NEUTRAL] The call reference would be my first name [PII], last initial of H and today's date.
[CUSTOMER][NEUTRAL] Uh, today's date. OK. Uh, uh, your name is [PII], right? Uh, could you please spell it?
[AGENT][NEUTRAL] Yes, it is spelled [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK, [PII]. OK. OK. Thank you so much and uh call reference number, your name and uh
[CUSTOMER][NEUTRAL] Which today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much, [PII], for your information and uh your patience. Thank you so much. Have a great day.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, Nick, have a great day as well.
[CUSTOMER][POSITIVE] Yeah, thank you.