AccountId: 011433970860
ContactId: 395c45e3-ac86-4405-a265-a7fc35e863d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448899 ms
Total Talk Time (AGENT): 82105 ms
Total Talk Time (CUSTOMER): 135166 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/395c45e3-ac86-4405-a265-a7fc35e863d8_20250210T17:58_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling IPL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. This is [PII], with the last name initial as [PII], calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah, that's [PII]. It's a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, sure. That's going to be.
[CUSTOMER][NEUTRAL] 1369753. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that. What day service.
[CUSTOMER][NEUTRAL] Yeah, that is [PII].
[CUSTOMER][NEUTRAL] With the total amount of $1,692 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Was this for a facility bill, anesthesia, doctors charge?
[CUSTOMER][NEUTRAL] Yeah, for anesthesia.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] OK, we did get that claim and it was denied.
[AGENT][NEUTRAL] We had met.
[AGENT][NEUTRAL] Hold on, yeah, we had met the maximum for that day.
[CUSTOMER][NEUTRAL] Uh, may I know when the claim was receipt?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 11725.
[CUSTOMER][NEGATIVE] And then it was denied.
[AGENT][NEGATIVE] Yes, it was denied.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] Let's see. 11725.
[CUSTOMER][NEUTRAL] On same day, may I know the denial reason once again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Maximum in the terms of like
[CUSTOMER][NEUTRAL] Units uh like visits.
[AGENT][NEUTRAL] They only get $1000 per calendar day.
[CUSTOMER][NEUTRAL] Has been reached.
[CUSTOMER][NEUTRAL] And they have maximum of $1000 per day.
[AGENT][NEUTRAL] For a calendar day.
[CUSTOMER][NEUTRAL] Like $1000 per year, I guess.
[AGENT][NEUTRAL] Calendar day.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Calendar. So what we have an excess of 1,692. 692 was.
[AGENT][NEGATIVE] Denied.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect. So, that's the patient, OK.
[CUSTOMER][NEUTRAL] So, one moment, please, if you don't mind.
[AGENT][NEUTRAL] A different patient?
[CUSTOMER][NEUTRAL] No, no, that's it. For this patient, I have only one patient. I'm having a query. Give me one moment.
[CUSTOMER][NEUTRAL] If you don't mind.
[CUSTOMER][NEUTRAL] Uh, actually, this claim was initially filed through Cigna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So after that one lady, yeah, they have made the remaining balance as a patient responsibility of $1,404.
[CUSTOMER][NEUTRAL] So we have some, uh, since we are exceeding $1000 OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah, they met their max with us so there's nothing else we can pay.
[CUSTOMER][NEUTRAL] Yeah, yeah, one second, yeah, I could understand one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, uh, could you please send a copy of your via fax because we haven't interested to see that, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] OK, I'll fax it to you.
[CUSTOMER][NEUTRAL] May I know when did you receive that fax?
[AGENT][NEUTRAL] So as we get off the phone, I can fax it to you.
[CUSTOMER][POSITIVE] OK. Thank you so much. May I know your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII], is there any call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. It was nice talking to you, by the way. Have a good day.
[AGENT][POSITIVE] Thank you for calling APLU as well.
[CUSTOMER][NEUTRAL] Bye.