AccountId: 011433970860
ContactId: 4bb82402-9210-4f8c-a736-c36e5567a9aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375959 ms
Total Talk Time (AGENT): 112067 ms
Total Talk Time (CUSTOMER): 116390 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/4bb82402-9210-4f8c-a736-c36e5567a9aa_20250424T16:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII] calling for provider office to check on a claim status. Could you please help me with that?
[AGENT][NEUTRAL] OK, you said your name was [PII]?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you have a phone number and in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yeah, callback number will be [PII]. It's a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah. So, so the member ID is 1369753 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Patient first name is
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can look that up for you. What date of service?
[CUSTOMER][NEUTRAL] The service will be [PII] with the total charge amount of $1,692 even.
[AGENT][NEUTRAL] OK, hold on one moment, please.
[CUSTOMER][NEUTRAL] Yeah. So I have a small specific question. Can I go ahead?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Sure, sir. Take your time.
[AGENT][NEUTRAL] And what was that procedure code on that bill?
[CUSTOMER][NEUTRAL] So we are built with the procedure code.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 01400.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, we did get that claim in. It was denied for [PII].
[AGENT][NEUTRAL] All they get is $1000 per calendar day.
[CUSTOMER][NEGATIVE] Sorry, I can't get you.
[AGENT][NEUTRAL] The claim was denied. Max met.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All they get is $1000 per calendar day.
[AGENT][NEUTRAL] And we already paid that to someone else.
[CUSTOMER][NEUTRAL] Yeah, so,
[CUSTOMER][NEUTRAL] Previously, we have received uh payment uh for Cigna.
[AGENT][NEGATIVE] So it was denied.
[CUSTOMER][NEUTRAL] So, uh, previously, some of our collector have send the claim back for reprocess on.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII]. Could you please check and tell me the status for the process which we have sent?
[AGENT][NEGATIVE] It has been denied for duplicate several times.
[AGENT][NEUTRAL] Because the max.
[CUSTOMER][NEGATIVE] So the process also denied as duplicate.
[AGENT][NEGATIVE] Yes, anytime you send it back in, it's going to be denied as duplicate because we've already denied it for Max Met.
[CUSTOMER][NEUTRAL] So what needs to be done on this?
[AGENT][NEGATIVE] Nothing, we can't pay anything because the max has been met.
[CUSTOMER][NEUTRAL] So the maximum amount has been met, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So we can bill the patient.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It was denied as Max Mt.
[CUSTOMER][NEUTRAL] Got it. Could you please share me the claim number, received and processed date?
[AGENT][NEUTRAL] The claim number that was denied as [PII].
[AGENT][NEUTRAL] was 351-386-3.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It was received 10-124.
[AGENT][NEUTRAL] And denied 104 24.
[CUSTOMER][NEUTRAL] 104 of 24, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it. So, yeah. Uh, we'll be checking.
[CUSTOMER][NEUTRAL] And we'll be billing the patient. Uh, so yeah, that's it for this number. Could you please share me your name and the call reference number?
[AGENT][NEUTRAL] My name is [PII] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it, [PII].
[CUSTOMER][POSITIVE] 424 of 2025. So yeah, that's it for the day. Thank you. Thank you for assisting. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII], for calling APA. You have a good day as well. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.