AccountId: 011433970860
ContactId: 0716ae1b-d02a-4111-b479-4d113730c06c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524599 ms
Total Talk Time (AGENT): 198216 ms
Total Talk Time (CUSTOMER): 107333 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/0716ae1b-d02a-4111-b479-4d113730c06c_20250124T15:25_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling ATL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII]. I'm calling from Bo office. I'm looking for a claim status.
[AGENT][POSITIVE] OK, yeah, [PII], I'd love to help you with claim status today and do you mind if I get a good callback number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] [PII]. Thank you. And what is the policy number we want to look at today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's going to be 023298-18.
[AGENT][NEUTRAL] And give me just a moment to get that pulled up for you my friend.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Thank you. And would you be able to verify for me, please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] And [PII], did you have a particular, uh, claim number you wanna look at or did you want me to search for by data service?
[CUSTOMER][NEUTRAL] The service is September [PII], 2023.
[AGENT][NEUTRAL] Mhm and uh uh dollar amount, the charge?
[CUSTOMER][NEUTRAL] $2275.
[AGENT][NEUTRAL] 275, you betcha.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, and can you verify the name of the facility on file?
[CUSTOMER][NEUTRAL] Facility, uh, the Kaufman Clinic IC.
[AGENT][POSITIVE] OK perfect I do see that here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like we received your claim. I'm so sorry that screen just disappeared on me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 23229.
[AGENT][NEUTRAL] Perfect. Here it is. It looks like we received your claim [PII]. It looks like the claim was processed on [PII], and your claim number is 33,800.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] How
[AGENT][NEUTRAL] 26
[AGENT][NEUTRAL] And I do show that claim had benefits payable of $75 via check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like the check number was um 1820272.
[AGENT][NEUTRAL] It was written on 11-8-2023 and it was cashed on [PII].
[CUSTOMER][NEUTRAL] OK, you said that claim received on [PII]. Claim number 3380026?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Paid amount $75.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Check number 18202772.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the issue date?
[AGENT][NEUTRAL] The issue date was the [PII].
[CUSTOMER][NEUTRAL] Mhm. OK. And can you give me the safety breakdown?
[AGENT][NEUTRAL] The what date?
[CUSTOMER][NEUTRAL] How much pay for each line a term?
[AGENT][NEUTRAL] How much was paid you're saying?
[CUSTOMER][NEUTRAL] How much pay for each line item, the 3 line item in the claim?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] Yes, absolutely. So that $75 paid out for the first line item, the 80061, um, and then the other two were denied stating that the maximum benefit for that date of service had been exhausted.
[CUSTOMER][NEUTRAL] What is the first, uh, which one is paid?
[AGENT][NEUTRAL] It paid $75 on that first line item, the 80061.
[CUSTOMER][NEUTRAL] But we submitted the claim with 99213 and G 008890674.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Let me pull up the opening claim. I'm sorry.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So I'm really sorry my system for viewing the claims is not um working but I'm gonna put you on a quick hold and I'm just gonna get you in touch with an examiner who processes the claims and they can help you out with that OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] this is can I help you?
[AGENT][NEUTRAL] Hi this is [PII] with the care team and um who am I speaking with? I'm sorry.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Hey [PII], hey, I have a provider on the line who's wanting information about um.
[AGENT][NEUTRAL] A claim
[AGENT][NEUTRAL] I'm sorry, my brain can't think. Um, I'm looking at policy number 2329818.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see here, are you wanting to transfer them?
[AGENT][NEUTRAL] Yeah, so my on base isn't loading, so I can't answer the rest of his questions. He wants to know what procedure codes were paid and why, um, and the procedure codes listed on the EOB online, um, don't match the procedure codes he said are on the claim, and so I can't view the original claim to help him.
[CUSTOMER][NEUTRAL] OK, what's his name?
[AGENT][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And it's the claim ending in 0026. I verified everything.
[CUSTOMER][NEUTRAL] OK, what is this callback number?
[AGENT][NEUTRAL] Yes, callback number is [PII] with an extension of [PII].
[CUSTOMER][NEUTRAL] OK, you can go ahead and put him first.
[AGENT][POSITIVE] Perfect and I'll introduce you Miss [PII] if that's OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hi [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Hey, thank you so much for your patience. I have Miss [PII] on the line and she's gonna take over the call and she'll be able to take care of you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in the claims department. How are you?
[CUSTOMER][NEUTRAL] Hi [PII], my name