AccountId: 011433970860
ContactId: e460f543-a6e1-49b3-8b4e-72b7323d6731
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 753270 ms
Total Talk Time (AGENT): 131586 ms
Total Talk Time (CUSTOMER): 313674 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/e460f543-a6e1-49b3-8b4e-72b7323d6731_20250310T14:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Car uh Cardiovascular Medicine Associate CA. Please be informed that this call is being recorded and monitored for the quality and training purposes. I verified the EOB and this call is made for the additional information about the denial.
[AGENT][NEUTRAL] OK, I can help you with your claim, um, and you said your name was Sale?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you, Miss [PII]. What is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, it is [PII] and that's a direct line.
[AGENT][NEUTRAL] Thank you and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And before that, may I have your name? I'm really sorry I missed it, Ma.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you so much. And I remember the name of the patient is [PII] and the date and the member ID is, I'm sorry, the member ID is 02163632. M as in Mike, L as in Lima, 8. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then what is the um.
[AGENT][NEUTRAL] The data service for the patient?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII].
[CUSTOMER][NEUTRAL] The total amount is $53.23.
[AGENT][NEUTRAL] OK and then what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] It is $53.23.
[AGENT][NEUTRAL] OK. And you said you were calling from cardiovascular Medical Associates, is that correct?
[CUSTOMER][NEUTRAL] Yes, correct. To check on a denial clarification.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] OK, what is the claim number that you have?
[CUSTOMER][NEUTRAL] Mm OK, let me check it. The claim number is.
[CUSTOMER][NEUTRAL] Mm, just to remind, uh, this call is being recorded and monitored for the quality and training purposes, and the claim number is 356 7.
[CUSTOMER][NEUTRAL] 594.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim. I'll be right back.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII].
[AGENT][NEUTRAL] I have the claim for you.
[AGENT][NEUTRAL] The claim number that you gave me 356-7594 is a duplicate claim that's why that one was denied, but the original claim is 3401495.
[AGENT][NEUTRAL] And that claim was denied because the services are not covered when performed in a doctor's office or clinic for the patient's policy.
[CUSTOMER][NEUTRAL] OK, you mean to say it's not covered as per the patient benefit plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. And sorry, may I know how your day is going?
[AGENT][POSITIVE] It's going good so far.
[CUSTOMER][POSITIVE] Uh thank you so much. I'm glad to hear that. Just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm just a moment please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][POSITIVE] And yeah it's getting ready.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Just a moment, getting ready, really sorry for the delay.
[CUSTOMER][POSITIVE] Just a moment, please, sorry. And thank you so much for that. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. May I know the
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know, the, uh, the corrected mailing address time filing is, sorry, uh, the time to filing limit for a collective claim will be 90 days from the date of service, is that right?
[AGENT][NEUTRAL] No, there's no time limit, you just need to send a letter why you wanna correct the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. There's no time limit, right? OK. Sorry, uh, just to reconfirm, uh, that, just to inform you on [PII], there was an action of the process taken place in this claim. And after that, it was denied, uh, for the reason, um.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh it's OK. The patient is not, uh, OK, just a moment. After the reprocess, um, the, it was denied again as the reprocess was not sent. After that, uh, we have submitted then, um.
[CUSTOMER][NEUTRAL] Collected claim and the claim was still on process on [PII]. And after that, it got denied, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. After the reprocess and the correct claim, it got denied. May I know when did you receive this claim, please?
[AGENT][NEUTRAL] Yes, ma'am. Let me look it up real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On [PII] and it was processed on [PII] originally.
[CUSTOMER][NEUTRAL] Uh, we have submitted on [PII], so could you please check that?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] I'm looking
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] OK, we received it actually on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And processed it on [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm, and just a moment. OK, there's no timely filing limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And I would like to verify the um just a moment please.
[CUSTOMER][POSITIVE] Just a moment please it's getting ready. OK. OK. OK, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you so much for that. And uh may I know the, I would like to verify the um mailing address.
[AGENT][NEUTRAL] Yes, the mailing address is [PII]. That's [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, just to reconfirm it is [PII] um.
[CUSTOMER][NEUTRAL] OK, [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And OK, thank you so much for your assistance. Could you please go ahead and provide the
[CUSTOMER][NEUTRAL] OK, this is the corrected mailing address, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for that. And could you please go ahead and provide the call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Mm thank you so much for that assistance and patience as well. Have a great day take care. Bye for now, [PII]. Thank you so much for your assistance.
[AGENT][POSITIVE] You're very welcome you have a wonderful day and thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.