AccountId: 011433970860
ContactId: 0cac3f46-4ab6-4e3c-b98a-4476c1b2be26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312579 ms
Total Talk Time (AGENT): 139899 ms
Total Talk Time (CUSTOMER): 86233 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/0cac3f46-4ab6-4e3c-b98a-4476c1b2be26_20250109T13:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. I'm calling from the business office of Saint Pan's Park to verify the denial of the claim on a recorded line.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to assist you with the claim denial clarity. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] policy number 00992120.
[AGENT][NEUTRAL] And that was 00992120?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's I'm sorry, policy number. May I have the date of service um for the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. The bill amount is $55,244.68.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 354-0278 and 23535474.
[AGENT][NEUTRAL] Do one and where's the original?
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Oh well it must be included in something then. Oh, there it is.
[AGENT][NEUTRAL] 3504681
[AGENT][NEUTRAL] 681
[AGENT][NEUTRAL] There's no denied claim.
[AGENT][POSITIVE] Alrighty.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] But that means that with that, the max was paid, I believe. I know that part.
[AGENT][NEUTRAL] PE 6013, OK, so that's all they had left of the max and what is the max cause they're gonna ask that.
[AGENT][POSITIVE] Max is, oh wait, that's impatient.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Oh, there we go, outpatient in the.
[AGENT][NEUTRAL] 2250 is the max. Mmm. I need to see that cause they don't even look, I don't know how to mm.
[AGENT][NEUTRAL] Um, policy number.
[AGENT][NEUTRAL] Almost at 2 minutes. 1234.
[AGENT][NEUTRAL] 56089.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, hello.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I have located the claim, and can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, um, so there's no on the original claim, there is no denial. It was paid out. We received it then twice after and it was denied as a duplicate. So are you wanting to go over the original claim or the, or why it was a duplicate?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, may I know the status of the payment on the original claim if, if it is already cash or not?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, so I'm showing check number 2001943 was cashed on [PII].
[CUSTOMER][NEUTRAL] That's quite crazy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Of [PII].
[CUSTOMER][NEUTRAL] Yeah that's do you have a bulk amount?
[AGENT][NEUTRAL] It's a single chair.
[AGENT][NEUTRAL] And it was in the amount of $2250 which is their outpatient maximum for the year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it. I think that's the only call reference number.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name, which is [PII]
[CUSTOMER][NEUTRAL] Yeah