AccountId: 011433970860
ContactId: 8bca5adc-4192-4d42-899b-67b07a651d5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618000 ms
Total Talk Time (AGENT): 147440 ms
Total Talk Time (CUSTOMER): 260047 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/8bca5adc-4192-4d42-899b-67b07a651d5b_20250516T16:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII] calling from products office checking on claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yup. Uh, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, uh, the policy number.
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEUTRAL] 1066.
[CUSTOMER][NEUTRAL] 922.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Uh, date of service.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $33,196 3196.
[AGENT][NEUTRAL] OK, we received it 3 times, so let me find which.
[AGENT][POSITIVE] I was right.
[AGENT][NEUTRAL] Uh, I received it 5-12-2025, process 5-15-2025.
[AGENT][NEUTRAL] The claim was denied as maximum amount payable for occurrence has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, total units are met.
[AGENT][NEUTRAL] So it, so occurrence is a treatment for the same or related condition unless separated by a period of 90 days.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's based on the condition that's being treated.
[AGENT][NEUTRAL] The time frame.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, just give me a second. Is it um
[CUSTOMER][NEUTRAL] OK, you're saying that uh the same uh.
[CUSTOMER][NEUTRAL] I mean, uh, the treatment of, uh, is repeatedly done, uh, right? I mean, within the 90 days.
[AGENT][NEUTRAL] Yeah, so they, so they can't receive treatment more than once in a ninety-day period for the same condition.
[CUSTOMER][NEUTRAL] But this is anesthesia services.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's not about any other, uh, I mean other uh other uh other treatments. It is uh anesthe services which are rendered, uh, while, uh, uh, surgery itself, surgery or any, um.
[CUSTOMER][NEUTRAL] Treatment given. At that time only we provide anesthesia services and for that we have built this claim.
[AGENT][NEUTRAL] Right, so we paid out the maximum on a different claim.
[AGENT][NEUTRAL] So we paid out the maximum dollar amount for this occurrence on a separate claim.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, uh, may I know it was it, uh, claim that you have already paid for?
[AGENT][NEUTRAL] We paid a separate claim for.
[CUSTOMER][NEUTRAL] I mean, I, I cannot.
[AGENT][NEUTRAL] Same date of service, different provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like I can't give you claim status on other providers.
[CUSTOMER][NEUTRAL] The same.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] I can provide you that one.
[AGENT][NEUTRAL] Provide what?
[CUSTOMER][NEUTRAL] I mean, uh, if I provide you the, uh, other, uh, provider name or details, uh, you can provide me the,
[CUSTOMER][NEUTRAL] Uh, pay details of that, right? I mean for that claim.
[AGENT][NEUTRAL] Yeah, you have the provider's name and bill charges.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] I think uh the claim is already paid you mean uh uh I mean it is already paid for Ny Pen Green, right?
[AGENT][NEUTRAL] What were the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, it is the same one. It is, uh, uh, [PII] and the total bill amount is $3,196 even.
[AGENT][NEUTRAL] Yeah, that's the claim that the amount you just gave me, right?
[CUSTOMER][NEUTRAL] Yes, yes. I mean, there are two providers, right? For you said one pro for one provider it is paid and for another provider, it is denied as, uh, I mean only uh once uh I mean uh this treatment can be paid only once in 90 days, right? They were saying before.
[AGENT][NEUTRAL] Correct, yes, we, we can only pay provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, for this 1 may I know for which claim it is paid, whether it is for, I mean for [PII] or for [PII].
[CUSTOMER][NEUTRAL] For which claim, I mean, for, for which provider claim it is paid and for which provider claim it is denied.
[AGENT][NEUTRAL] So what are the bill charges and what's the provider's name?
[CUSTOMER][NEUTRAL] I mean, uh, the same, uh, the same date of service and the bill amount you said.
[CUSTOMER][NEUTRAL] Uh, there are, there is a claim that was paid for the same date of service for another claim for another, uh, provider, right? Is that, I mean, there are two providers in my, I can see here that is [PII] and [PII].
[CUSTOMER][NEUTRAL] So I'm asking them uh for which provider is that it is paid and for which provider it is denied.
[AGENT][NEUTRAL] Right, and I'm, I'm asking you, I can't give you claim status unless you provide the name of the provider and the bill charges.
[CUSTOMER][NEGATIVE] Because I don't have any paid information from this.
[AGENT][NEUTRAL] So what's the name of the provider and the bill charges your checking status on?
[CUSTOMER][NEUTRAL] Ny green pen.
[AGENT][NEGATIVE] I don't show that uh we've paid anything to that.
[CUSTOMER][NEUTRAL] Uh, what about [PII]?
[AGENT][NEUTRAL] No, I, I don't show a payment to that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh, for which claim it is paid because we have built only two claims. That was one for [PII] and the other for [PII].
[AGENT][NEGATIVE] Right, it's not paid on either of those.
[CUSTOMER][NEGATIVE] For both it is not good.
[AGENT][NEUTRAL] So I, like I said, I
[CUSTOMER][NEGATIVE] OK, for both, it is not good.
[AGENT][NEUTRAL] Correct, yes. So, I can only give you claim status for which you provide me details. I can't give you claim status on any other claims, if you're not the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Apart from apart from uh these two providers, there is one more claim for the date for the same date of service which is paid.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, is that a hospital claim?
[AGENT][NEUTRAL] You have the bill charges and the hospital name?
[CUSTOMER][NEUTRAL] I mean, uh
[CUSTOMER][NEUTRAL] Memorial Hospital.
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] Uh yeah, it is the same, the $3,196 even.
[AGENT][NEUTRAL] I don't, I don't have a claim for a hospital with that filled them out.
[AGENT][NEUTRAL] I like I said, I can only give you claim status if you're calling for the provider, which I, I thought that's the only claim status I can give you. I can give you the denial. Do you need me to send you the EOB denial?
[CUSTOMER][POSITIVE] Yep, um, yep, you can practice that you'll be uh.
[AGENT][NEUTRAL] OK. What's the fax?
[CUSTOMER][NEUTRAL] And um yep.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes about 5 minutes. Anything else I can help with today?
[CUSTOMER][POSITIVE] Uh, nothing else, thank you.
[AGENT][POSITIVE] OK, thanks for calling AT.
[CUSTOMER][NEUTRAL] And you can provide me the call reference.
[AGENT][NEUTRAL] That's just my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thank you for that, [PII].
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.