AccountId: 011433970860
ContactId: d79c9609-9f6c-4216-84bf-d5d0d917d437
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 830179 ms
Total Talk Time (AGENT): 225516 ms
Total Talk Time (CUSTOMER): 101605 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/d79c9609-9f6c-4216-84bf-d5d0d917d437_20250513T20:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I needed to get some information please.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the information. What type of information did you need?
[CUSTOMER][NEUTRAL] Um, there's one there's two claims that we had sent to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One of them says you sent the payment to the patient and the other one says it's a duplicate.
[AGENT][NEUTRAL] OK, so you want to go over claim status. OK. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that, [PII]. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 17 0 hold on I'll tell you right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 013.
[CUSTOMER][NEUTRAL] 59721.
[AGENT][NEUTRAL] 01359721?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have either the dates of service and the total bill or the claim numbers?
[CUSTOMER][NEUTRAL] The the first day of service is [PII] for 6-18.
[AGENT][NEUTRAL] [PII], and you said for 6-18?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh huh, [PII]. I have a claim number if you need it.
[AGENT][NEUTRAL] Um, yes, the claim numbers will be fine.
[CUSTOMER][NEUTRAL] 358
[CUSTOMER][NEUTRAL] 656 5.
[AGENT][NEUTRAL] And did you have any other claim numbers?
[AGENT][NEUTRAL] To look at.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] 6464.
[AGENT][NEUTRAL] OK. And do you mind if I place you on just a brief hold while I look at these claims?
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, 618, what's the total bill?
[AGENT][NEUTRAL] Like I said, 6:18.
[AGENT][NEUTRAL] And this 1 46464 is a duplicate of what's this data service? Oh Lord.
[AGENT][NEUTRAL] 26, so this one is [PII].
[AGENT][NEUTRAL] What's the total bill.
[AGENT][NEUTRAL] 0 10:19 OK.
[AGENT][NEUTRAL] I was gonna to say sorry.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] Right, but what's the dupe though? I mean, what's the original, so I'm trying to figure out. Here it is.
[AGENT][NEUTRAL] Oh, wait a minute.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] 227-2050.
[AGENT][NEUTRAL] That's different. OK, hold on.
[AGENT][NEUTRAL] What is that 327. 0 no.
[AGENT][NEUTRAL] 227.
[AGENT][NEUTRAL] H
[AGENT][NEUTRAL] Well, what's the.
[AGENT][NEUTRAL] OK, wait a minute.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, above the claim to be do and the benefits paid to the insured. OK, where's the, I just went under.
[AGENT][NEUTRAL] C L HQ.
[AGENT][NEUTRAL] 07 2628.
[AGENT][NEUTRAL] So is this the uh
[AGENT][NEUTRAL] 222-0854
[AGENT][NEUTRAL] Here it is. It has to be that.
[AGENT][NEUTRAL] But they have that for the whole, OK, wait.
[AGENT][NEUTRAL] 2220854.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, but that's just that one thing. What was paid to the insured?
[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][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I had to do a little digging. Um, so yes, so the issue is not really an issue, but what's happening is the patient is submitting the claims before you all submit the claim. So,
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The what you all are filing for has already been paid to the claim that the patient um filed because the patient filed it first. If something is owed to you all, then the patient will have to pay you because the, the claim paid to the patient.
[CUSTOMER][NEUTRAL] So you paid both claims to the patient?
[AGENT][NEUTRAL] Yes, that's, yes, yours are duplicate because we paid the first claims that came in which the patient submitted.
[CUSTOMER][NEUTRAL] Do you know when you paid them?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Let me see, 854, hold on one moment. That one was paid.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see the 2nd 1.
[CUSTOMER][NEUTRAL] And you guys paid the 149.50 right?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Um, how can I get around this? Um,
[CUSTOMER][NEUTRAL] That's fine, don't worry, it's.
[AGENT][NEGATIVE] I'm hesitant
[AGENT][NEUTRAL] OK, um, the next day of service, July, hold on, [PII]. Let me see.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's like a million claims because they, they had to resubmit too, so hold on one second.
[CUSTOMER][NEUTRAL] It was last
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 942.
[AGENT][NEUTRAL] Oh, OK, it's the same day. That's also [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was I guess it was for the the hold on.
[CUSTOMER][NEUTRAL] That's the 1961, hold on.
[CUSTOMER][NEUTRAL] It was for 19672, right?
[AGENT][NEUTRAL] That we paid to them?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] I can't give that amount.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But for both claims, it, it was.
[CUSTOMER][NEUTRAL] OK, that's fine. I'll just call them the bill.
[AGENT][NEUTRAL] Alright, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Can I just get a reference number sweetie?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um, again, my name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.