AccountId: 011433970860
ContactId: 0e0ab111-4653-4e9f-8d7b-043c7d8faf80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471640 ms
Total Talk Time (AGENT): 146262 ms
Total Talk Time (CUSTOMER): 129352 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/0e0ab111-4653-4e9f-8d7b-043c7d8faf80_20250417T19:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling PO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is, uh, [PII] calling from the provider's office regarding our client status or in our clarification.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm missing a digit. Can you repeat that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you. May I have the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] It's Ellington Clinic PPSC.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] D as in David, 42,031,850.
[AGENT][NEUTRAL] Um, do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be your number. This number is not ours.
[CUSTOMER][NEUTRAL] Yeah, it's D as in David, 4203185.
[AGENT][NEUTRAL] That the number is not ours. Do you see any other numbers?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah it's 05 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 646-663
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the last name is spelled like [PII], [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. How much is the total charge?
[CUSTOMER][NEUTRAL] $313 even.
[CUSTOMER][NEUTRAL] 056.
[AGENT][NEUTRAL] Yeah, OK, thank you. All right, let me see if I can find this claim for you and for the future, you can check claim status online through our website at [PII], and that's just an option.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Do you know what's the procedure code?
[CUSTOMER][NEUTRAL] Oh yeah. 87426.
[AGENT][NEUTRAL] OK, so I just gonna be this one, bear with me just a second, let me pull this in.
[AGENT][NEUTRAL] OK, I'm waiting on the system.
[AGENT][NEUTRAL] It looks like we processed this claim on [PII] and we send a benefit amount of $50 to the provider.
[CUSTOMER][NEUTRAL] The claim was denied the maximum.
[CUSTOMER][NEUTRAL] Benefit payable for this uh data service has been met, but this is the lab code service.
[CUSTOMER][NEUTRAL] But at the same time, we have received the payment for 99213 CPT code and same date of service. So can, can you check with the
[CUSTOMER][NEUTRAL] My family did not reason why it was denied.
[AGENT][NEUTRAL] $50 is the maximum benefit payable for that date of service.
[AGENT][NEUTRAL] So with the payment of that $50 the maximum has been exhausted for that data service.
[CUSTOMER][NEUTRAL] For, for the home home, I'm sorry.
[CUSTOMER][NEUTRAL] for the date of service, it is $50 right?
[AGENT][NEGATIVE] Correct, we pay $50 per day of service. So when the payment of the $50 she exhausted the benefit for that date of service.
[CUSTOMER][NEUTRAL] Because for the
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] First for the date of service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] Yes for the, as for the provider's contact, right?
[AGENT][NEUTRAL] Me's policy.
[CUSTOMER][NEUTRAL] As per as per the members.
[CUSTOMER][NEUTRAL] Numbers policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, if you not agree with this, what can we do nowadays?
[AGENT][NEUTRAL] You have 180 days from the denial date to submit an appeal.
[CUSTOMER][NEUTRAL] What is your fax number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] OK, what is the
[CUSTOMER][NEUTRAL] Mailing address.
[AGENT][NEUTRAL] OK, that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] All reference number.
[AGENT][NEUTRAL] We don't have reference numbers so you can use my name and today's date if you will.
[CUSTOMER][NEUTRAL] Family filing limit.
[AGENT][NEUTRAL] 180 days from the 180 days from the decision date.
[CUSTOMER][NEUTRAL] Family falling limit.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Budget for today.
[AGENT][POSITIVE] OK. Thank you for calling ATL. Have a good afternoon.
[CUSTOMER][NEGATIVE] You are on hold