AccountId: 011433970860
ContactId: fb1c7e87-8011-49c1-9249-20b6d0792c33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 566130 ms
Total Talk Time (AGENT): 201439 ms
Total Talk Time (CUSTOMER): 103552 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/fb1c7e87-8011-49c1-9249-20b6d0792c33_20250623T13:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of provider office to check on client status are you doing today?
[AGENT][NEUTRAL] I'm doing fine. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] OK [PII] and you're needing claim status correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] The callback number is [PII] and there is no extension.
[AGENT][NEUTRAL] Thank you. And what, how many claims were you do you have to check status on?
[CUSTOMER][NEUTRAL] OK one.
[AGENT][NEUTRAL] OK. And what is that patient's policy number?
[CUSTOMER][NEUTRAL] OK, and the policy number is 02465058.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And you said that policy number is, OK, one moment. My system, give me just one second for you.
[AGENT][NEUTRAL] Anyway, again, any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] OK. And the patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] OK, and the date of service is [PII]. The charge amount is 400 and
[CUSTOMER][NEUTRAL] $7310.01.
[AGENT][NEUTRAL] OK, you said that was data service 101 to 106 for $407,310.01. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we have a claim that was received um for the provider. Give me one moment.
[AGENT][NEUTRAL] That claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 5920.
[AGENT][NEGATIVE] This claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial states the above reference claim appears to be a duplicate of previously submitted expenses, excuse me, benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the original claim number?
[AGENT][NEUTRAL] Yes, ma'am. I just gave that to you.
[AGENT][NEUTRAL] Oh, I can't provide you the original claim number in which the claim is processed. I can only provide you your claim number.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits with that remark on it, Rhea, you can print that by going to our portal and using the claim number that I gave you, and our website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK. And the
[CUSTOMER][NEUTRAL] Sorry, uh, could you please repeat that name again?
[AGENT][POSITIVE] Yes, ma'am. It is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh could you please provide me the general client number?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I gave you your claim number. I cannot provide you another, the other claim number. I gave you the claim number we received for your provider.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. It is 359-592-0, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and it is then that's duplicate, correct?
[AGENT][NEUTRAL] Yes, ma'am. I read you the remark.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Uh, but I need the original.
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] Yes, ma'am, and I read the whole remark that state's benefit payment has been made to the insured, and I cannot provide you that claim number for the original claim that was received from someone else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it is the, for the same date of service?
[CUSTOMER][NEUTRAL] Same charge amount?
[AGENT][POSITIVE] Yes, ma'am and yes.
[CUSTOMER][NEUTRAL] But uh without the uh general claim, we can't able to provide, uh, could we take this for reprocess?
[AGENT][NEUTRAL] Then you can request an appeal in writing within 180 days from the date of the decision if you choose to, and you would send that appeal to the same address as claims, but make sure it is put to attention appeals department.
[CUSTOMER][NEUTRAL] OK. And it is uh from the different provider, right? The other claims from?
[AGENT][POSITIVE] As I explained, we received it and it was processed and paid to the insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, just one minute.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. And could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] My name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK. And thank you for your time and assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Well, you're very welcome. Yes, you too. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well then thank you for calling APL and I hope you have a nice day.
[CUSTOMER][POSITIVE] OK. Have a great day.
[AGENT][NEUTRAL] Uh, you too. Bye-bye.