AccountId: 011433970860
ContactId: 79696fa5-ed41-428c-b913-9b8dad992330
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 950750 ms
Total Talk Time (AGENT): 320625 ms
Total Talk Time (CUSTOMER): 170483 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/79696fa5-ed41-428c-b913-9b8dad992330_20250313T17:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, you can assist me as Avi. A for Alpha, V for Victor, I for India, initial is B, B for boy.
[AGENT][NEUTRAL] OK, how may I help you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, actually I need a claim status for the number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And may I have
[CUSTOMER][NEUTRAL] Could you please give me the time?
[AGENT][NEUTRAL] Sure, I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] All right. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] The Holy Cross Hospital.
[AGENT][NEUTRAL] My
[AGENT][NEUTRAL] All right. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's um
[CUSTOMER][NEUTRAL] 0184.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 6260
[CUSTOMER][NEUTRAL] M for Mike, L for Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Mm OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The uh there you are. [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The data service is 8-15-2023 and uh build modem is the 9512.
[CUSTOMER][NEUTRAL] And 5 cents.
[AGENT][NEUTRAL] OK, you said the date of service was [PII], the amount $9,512.05.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][POSITIVE] It's correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and for the future, you can check claim status online through our website at [PII] and I'm gonna put you on a brief hold while I search for this claim, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] For holding and being patient for me Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No. OK, so it looks like, um, OK.
[CUSTOMER][NEUTRAL] Yeah, I miss them.
[AGENT][NEGATIVE] It looks like we have processed this claim 3 times, so the most recent one was denied as a duplicate, and I have the original claim pulled up.
[AGENT][NEUTRAL] Um, the original of claim was processed [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. What was the date?
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Uh, [PII]. OK, what was the claim status?
[AGENT][NEUTRAL] OK, the claim has been denied. The reason for this denial is that the maximum benefit payable for the date of service has been met.
[CUSTOMER][NEGATIVE] Denied.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK, could you repeat again what was the reason for this delay?
[AGENT][NEUTRAL] OK, and the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] Maximum?
[CUSTOMER][NEUTRAL] Maximum benefits payable on the data service, right?
[AGENT][NEUTRAL] Yes, mhm, right.
[CUSTOMER][NEUTRAL] What was the denial date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is there any, OK, give me, uh, please let me hold on 2 minutes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thanks for being on hold.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So you said that uh maximum benefit payable from the service. So please, could you explain the uh it's a visit.
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, maximum benefits are, uh, maximum benefits are visiting plans are uh dollars plan.
[AGENT][NEUTRAL] It's gonna be dollar value because this has a daily benefit amount. So this one has a daily benefit amount and the maximum payable for that date of service has been met. So it's the dollar value, and that was $500 per day.
[CUSTOMER][NEUTRAL] Hello, OK, 5 $100 per day.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK. Is there any, any possible to reprocess the claim?
[AGENT][NEGATIVE] We already processed twice and it was denied as a duplicate because it was processed correctly the first time.
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] The most recent claim that we received, let me give you this information so you have it on your records as well, OK? One moment.
[CUSTOMER][NEUTRAL] OK, I already
[CUSTOMER][NEUTRAL] OK, you said that uh
[AGENT][NEUTRAL] OK, so the most recent claim was received on [PII].
[AGENT][NEUTRAL] So that's the most recent submission was [PII], and it was processed on [PII], and it was denied indicating that it was a duplicate because the original one was denied correctly, which the denial reason is the maximum benefit payable for the date of service has been met.
[CUSTOMER][NEUTRAL] OK, uh, dinner as do we get.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But what was the original claim status?
[AGENT][NEUTRAL] That is the original claim status that it was denied because the maximum benefit has been exhausted.
[CUSTOMER][NEUTRAL] OK, first one, it's process date is [PII].
[CUSTOMER][NEUTRAL] It is due to maximum benefits from the data service. It's a do we get, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. The original claim, which it was processed [PII], was denied, maximum benefit has been exhausted. That is the denial on [PII]. The most recent claim, which it was processed on [PII], was denied as a duplicate because the original claim was processed correctly.
[CUSTOMER][NEUTRAL] OK, I'm asking about the process correctly, that one, I'm asking that the status, the claim status.
[AGENT][NEUTRAL] That is the claim that we process. OK, Mr. uh uh [PII], that is the claim that we processed [PII]. [PII] is the original claim.
[CUSTOMER][NEUTRAL] Original claim
[AGENT][NEGATIVE] That was denied as maximum benefit has been exhausted.
[CUSTOMER][NEUTRAL] OK. Is there any other option to reprocess the claim for [PII]?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm, I don't see any other because um we have an appeal, but the appeal is just 180 days from the decision date. This has been, this has been since [PII]. So, um, the appealing time is, is done. There's not an appeal time frame right now because it's out of that 180 days. Um, and again, this claim has been submitted twice after that, one in [PII], 1 in [PII], and it's still the same denial.
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] Oh, it's been processed 3 times, OK. Uh, the original claim, OK, the original claim was processed on, um, the claim number is 337.
[CUSTOMER][NEUTRAL] OK, I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2964.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The most recent claim, which is denied as a duplicate and is the most recent one we received on the [PII] is 35719.
[CUSTOMER][NEUTRAL] This claim number, right?
[AGENT][NEUTRAL] Yeah, that's the claim number for the most recent one, for the duplicate. OK, 357.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK. 37
[AGENT][NEUTRAL] 1999.
[CUSTOMER][NEUTRAL] OK, what was the issue date for OK, receive is March and process this. OK. Then I to, is there any payer ID for original?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Ask me your payer ID.
[AGENT][NEUTRAL] The payer ID, uh, this one is a secondary. We, we ask for the claims to be faxed or mail. Um, I can, if you need the payer ID it's just gonna be like for reference, but it's not gonna be for you to submit claims. So what's the purpose of the.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] ID.
[CUSTOMER][NEUTRAL] OK, can you please, uh, let me hold on 2 minutes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for being on hold.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, it's clear. Uh, so what's your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last [PII].
[CUSTOMER][NEUTRAL] OK, what was the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers so you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK. Username and this date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sir. Thank you for giving this information.
[AGENT][POSITIVE] You're welcome and thank you you as well and thank you for calling APO. Bye-bye, Mr. [PII].
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Yeah.