AccountId: 011433970860
ContactId: 83cfb5db-5d19-47c4-9680-80353999bd57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300640 ms
Total Talk Time (AGENT): 133316 ms
Total Talk Time (CUSTOMER): 86048 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/83cfb5db-5d19-47c4-9680-80353999bd57_20250122T13:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm calling from NMed Urology and I have a question about a um payment for a deductible for a patient.
[AGENT][NEUTRAL] OK, so this is regarding a claim that has been filed or you have a question on the benefits for the policy?
[CUSTOMER][NEUTRAL] No, it's about a claim that was filed and the patient spoke with someone that said that the claim would be paid by um APL after Cigna uh left it to the patient's deductible but it has been denied twice.
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with claim status, hey, and what is your call back number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It is 02465453.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments, [PII], to get all the information pulled up for the member, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you I appreciate your patience so just a moment.
[AGENT][NEUTRAL] OK, and say, any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, her name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Day of service is [PII]. Total charge is $1,384.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so the most recently received claim was denied as a duplicate. It's been received, um, let's see.
[AGENT][NEUTRAL] It looks like it's been received several times, actually.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah I've tried to, I've tried to send the claim along with the um primary EOB is what the patient requested.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] So give me a moment to look at the original claim receipt.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the original claim that was received was 3455537.
[AGENT][NEUTRAL] And the remarks.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] States outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The, yes, the outpatient calendar, your maximum benefit for covered outpatient services is $2000 and that was met on a claim that was received prior to this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, great, and may I get a reference number please?
[AGENT][NEUTRAL] And then if you need a.
[AGENT][NEUTRAL] Absolutely, and [PII], if you need a copy of this explanation of benefits, you can go to our portal at [PII] and you should be able um to print that off from there but for the reference number you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much for all your help.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else that I can help you with this morning?
[CUSTOMER][POSITIVE] No, that was what I needed answered. I appreciate your help.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Absolutely, [PII]. So thank you again for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you as well.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. Bye bye.