AccountId: 011433970860
ContactId: f0e25e25-fac8-4d95-88c9-c5176ef03d81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695250 ms
Total Talk Time (AGENT): 202055 ms
Total Talk Time (CUSTOMER): 193987 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/f0e25e25-fac8-4d95-88c9-c5176ef03d81_20250519T17:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from Medical University Hospital Authority to check on the claim status.
[AGENT][NEUTRAL] OK, did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and my last name initial is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And you're needing claim status. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yeah, actually, the claim is denied as a duplicate, and they have taken for reprocess. So may I know the current status of the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're wanting to check claim status, is that correct for one member?
[CUSTOMER][POSITIVE] Yeah, it's yeah, it's correct. For one member.
[AGENT][NEUTRAL] Yes, I can help you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member policy number is.
[CUSTOMER][NEUTRAL] 02560355
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient name is [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is on [PII] and the total bill amount here is $4,756 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Could you please spell your name for me?
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] OK. I see.
[AGENT][NEUTRAL] OK, so you're wanting the original claim information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, in previous, uh, according to previous step.
[CUSTOMER][NEUTRAL] It's like, uh, it is, uh, the claim is, uh, belongs to a different uh provider. So rep verify and take back the claim for the process on uh [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, what is the tax ID for your provider?
[CUSTOMER][NEUTRAL] Yeah, the tax ID number here is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so this claim had been received uh before for this provider and the benefit had been paid?
[AGENT][NEUTRAL] The original claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] And that claim number was 354-8588.
[AGENT][NEUTRAL] And there was a benefit paid in the amount of $124.19.
[CUSTOMER][NEUTRAL] 19, right?
[AGENT][NEUTRAL] I'm sorry. I, I didn't hear you.
[CUSTOMER][NEUTRAL] It is 1
[CUSTOMER][NEUTRAL] Is it 124.19 or 90?
[AGENT][NEUTRAL] The amount 124.19.
[CUSTOMER][NEUTRAL] The paid amount. Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was paid on single check 202.
[AGENT][NEUTRAL] 1766.
[AGENT][NEUTRAL] And that check did clear on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 16
[CUSTOMER][NEUTRAL] OK. May I know the check number?
[AGENT][NEUTRAL] 2021766.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the thing, it's a single amount or a bulk amount?
[AGENT][NEUTRAL] Single. All of our checks are single checks.
[CUSTOMER][NEUTRAL] OK. So may I know the allowed amount?
[AGENT][NEUTRAL] This is a supplemental policy that helps with deductibles, co-pays, and co-insurance amounts of covered services, and the 124.19 was the benefit amount.
[CUSTOMER][NEUTRAL] OK. Give me a second. Let me check with them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the date of service for the original claim?
[AGENT][NEUTRAL] The same data service that you just gave me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits to go with the claim number that I gave you, you can print that by going to our portal, Cathy, located at [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Give me a second. Let me check with this.
[CUSTOMER][NEUTRAL] May I know the bill amount for that claim, original claim because upon checking on the system, I could not find the claim, original claim.
[AGENT][NEUTRAL] The billed amount that you gave me. Yes, ma'am. The billed amount you gave me, that's, I checked the billed amount and the, and the date. That's the only thing I checked. Mhm.
[CUSTOMER][NEUTRAL] It's the same, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please verify with the provider's name? Is that the same?
[AGENT][NEUTRAL] Is the same tax ID number that you provided for me, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Upon checking on the system, I do not find the claim original claim here.
[AGENT][NEUTRAL] Yeah, I just gave you the original.
[CUSTOMER][NEUTRAL] For the data service, 125.
[AGENT][NEUTRAL] Yes, ma'am, we received the claim.
[CUSTOMER][NEUTRAL] OK. Actually,
[CUSTOMER][NEUTRAL] OK. Actually, the claim is denied as duplicate, right?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] No ma'am, the most recent yes ma'am, the most recent claim was denied as a duplicate because the claim number that I gave you is the claim number that we processed and paid the claim on.
[CUSTOMER][NEUTRAL] But this claim is paid.
[CUSTOMER][NEUTRAL] OK. So I, I want to claim status for the claim number.
[CUSTOMER][NEUTRAL] 3593573
[AGENT][NEUTRAL] Denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] OK. May I know the denied date? Actually, as for the previous time, it was denied as duplicate under the different providers, so they took back for reprocess this claim. So may I know the exact status of that? It's still in process or uh it's processed?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] No ma'am.
[AGENT][NEUTRAL] No ma'am, it wasn't sent back. It was denied as a duplicate, and that is correct. It was the same exact claim as the one we processed.
[CUSTOMER][NEUTRAL] Yeah, it was sent back on [PII].
[AGENT][NEUTRAL] Yes ma'am, because we had already paid the claim under the claim number that I just gave you, so yes ma'am, denying it as a duplicate was correct.
[CUSTOMER][NEUTRAL] OK. Actually, the claim.
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, may I know the call reference of this claim for for this call?
[AGENT][NEUTRAL] The call reference number you would use my name along with today's date.
[AGENT][NEUTRAL] And if you need the first initial to my last name, [PII], it's [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your information. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] I hope you have a nice day as well and thank you again for calling APL.