AccountId: 011433970860
ContactId: b893c4ea-b320-440b-84ff-5c9652fe6b71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359549 ms
Total Talk Time (AGENT): 100269 ms
Total Talk Time (CUSTOMER): 132349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/b893c4ea-b320-440b-84ff-5c9652fe6b71_20250411T17:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from NYU to check on a claim status. How are you doing today?
[AGENT][NEUTRAL] I'm doing fine, [PII]. How are you? Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I, I do have the policy number here. The policy number which I have here is 02559264.
[AGENT][NEUTRAL] Hold on one moment, please.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] Uh, yeah, it's uh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII], and you're needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can help you with that. What data service?
[CUSTOMER][NEUTRAL] Yeah, the date of service I'm checking for is on [PII].
[AGENT][NEUTRAL] OK, and what procedure code was on that bill?
[CUSTOMER][NEGATIVE] Uh, the procedure code 8342, which is being denied here.
[AGENT][NEUTRAL] And was that the only one, or were there 2 more on that bill?
[CUSTOMER][NEUTRAL] I have only, I have 2 or 3 CPTs here. The 2 CPTs have been paid and only 1 CPT is dinner, that is 8342.
[AGENT][NEUTRAL] OK, we did get it in, we did deny it. The max was met for that day.
[CUSTOMER][NEUTRAL] OK. So the, uh, may I know the maximum units allowed per data service?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] $500 per calendar day.
[CUSTOMER][NEUTRAL] Uh, you mean, may I have the units in the terms of units one unit or two units like that, [PII]?
[AGENT][NEUTRAL] It's not like that. It's 500 per day, period.
[CUSTOMER][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] Uh, one moment. Let me 500 per day. So,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We have billed that $557 per date of service. So is it impossible for you to pay the claim, I mean, pay, pay for that CPG?
[AGENT][NEUTRAL] No, did you not hear what I was telling you? The max has been met for that day. You only get $500 per calendar day.
[CUSTOMER][NEUTRAL] OK. OK. Is it possible for us to submit a reconciliation for this claim?
[AGENT][NEUTRAL] You can, yes, ma'am. You can submit a pill, but it's gonna be 9 again.
[CUSTOMER][NEUTRAL] OK. Uh, we'll just go ahead and submit a medical records. So for the same reason, we'll work on differently. Uh, in that case, may I have the denial date of the claim?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It was denied [PII].
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, yes. May I have the mailing address and the timely filing limit to submit the medical records?
[AGENT][NEUTRAL] We do not have timely filing. The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So if we submit the medical records, will you be considering it as an uh appeal or a reconsideration?
[AGENT][NEUTRAL] It would be an appeal because the max has been met on the policy. There's nothing else we can pay.
[CUSTOMER][NEUTRAL] OK, it's in the first level appeal. OK. Uh, in that case, may I have the call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] [PII], OK. OK. Is it possible for you to provide me the uh fax number also for the submit the medical records?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK. [PII]. OK. OK, [PII]. In that case, uh thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Correct. Mhm.
[AGENT][POSITIVE] Thank you, sir, for calling IPL. You as well.
[CUSTOMER][POSITIVE] OK, thank you.