AccountId: 011433970860
ContactId: fca55570-d5dd-49c8-aa35-4f6de12941e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369279 ms
Total Talk Time (AGENT): 114247 ms
Total Talk Time (CUSTOMER): 137370 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/fca55570-d5dd-49c8-aa35-4f6de12941e9_20250116T14:28_UTC.wav
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[AGENT][NEUTRAL] Called APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from Piedmont.
[CUSTOMER][NEUTRAL] Health
[CUSTOMER][NEUTRAL] And I was calling to check the status to see if you received a claim.
[AGENT][NEUTRAL] Good morning. Yes, I can help you with claim status and in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes honey, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number, please?
[CUSTOMER][NEUTRAL] Yes, that is 02468742.
[AGENT][NEUTRAL] Thank you, and that was 02468742?
[CUSTOMER][NEUTRAL] Yes, wait, let me repeat that. 02468742.
[AGENT][NEUTRAL] Thank you. And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is, hold on just one second.
[CUSTOMER][NEUTRAL] Day of service is [PII] and the amount of $13,785.88.
[AGENT][NEUTRAL] Thank you. So that's for dates of service of [PII] for $13,785.88.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I show we did receive that claim in.
[AGENT][NEUTRAL] It was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Hold on just a minute, when it was received.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] And nothing was paid on this claim because this is a duplicate claim that was previously submitted and benefits were paid to the insured.
[CUSTOMER][NEUTRAL] OK, hold on, no payments.
[CUSTOMER][NEUTRAL] We issued.
[AGENT][NEUTRAL] It's a duplicate claim. Payments were made out to the patient.
[CUSTOMER][NEUTRAL] Because it
[AGENT][NEUTRAL] To the insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Duplicate claim.
[CUSTOMER][NEUTRAL] And do you have, can I get the claim number?
[CUSTOMER][NEUTRAL] The original claim number please.
[AGENT][NEUTRAL] The, the claim was filed by the insured. You'll have to contact the insured in regards to that. It looks like the insured filed the claim before your claim. So you'll have to contact the patient regarding the details of that. Yes.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] OK, hold on, let me make note of this.
[AGENT][NEUTRAL] So that's why it's a duplicate claim.
[AGENT][NEUTRAL] Because it was previously filed by the insured.
[CUSTOMER][NEUTRAL] Well, it, when it doesn't.
[CUSTOMER][NEUTRAL] Well, that, that doesn't necessarily mean that when you say duplicate, we're talking I'm, I'm thinking about us. I'm not thinking about the insured. So, OK, so, um, no claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hold on just
[CUSTOMER][NEUTRAL] OK, number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so you're saying we are the duplicators because he already filed, this patient already filed the claim first for us, so.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I'm
[AGENT][NEUTRAL] Yeah, I'm saying that this is a, a duplicate of a previous submitted submitted expense and it was submitted by the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] Why would you do that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK. Um.
[AGENT][NEUTRAL] Did you want the claim number for this claim that was processed on the [PII]?
[CUSTOMER][NEUTRAL] Yeah, hold on just a.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on just a minute. I'll get that duplicate number.
[CUSTOMER][NEGATIVE] I'm just like, I don't know, I can't, I just can't make this up.
[CUSTOMER][NEUTRAL] Uh, hold on, OK. OK.
[CUSTOMER][NEUTRAL] What is that claim number?
[AGENT][NEUTRAL] It's 3506731.
[CUSTOMER][NEUTRAL] OK, and [PII], can you give me a reference number for this call, please?
[AGENT][NEUTRAL] It'd be just my name in today's date, and that's [PII] spelled [PII]
[AGENT][NEUTRAL] Is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much [PII] you have a good day hon.
[AGENT][POSITIVE] You're welcome. You too. Thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Bye bye.