AccountId: 011433970860
ContactId: 16d2c9d8-4edb-4420-a666-1f7c70273397
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286190 ms
Total Talk Time (AGENT): 148081 ms
Total Talk Time (CUSTOMER): 91908 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/16d2c9d8-4edb-4420-a666-1f7c70273397_20250617T17:45_UTC.wav
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[AGENT][NEUTRAL] of
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for contacting ATL. My name is [PII]. Hello, I'm sorry, I can't hear you. Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh yes, sir. Uh, I, this, yeah, yeah, I can hear you. My name is [PII] and I'm calling from provider office for the claim status.
[AGENT][NEUTRAL] So, hello?
[AGENT][NEUTRAL] OK, [PII], my name is [PII] and thank you for contacting ATL. What is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Policy number is 0188.
[CUSTOMER][NEUTRAL] 729 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Uh date of birth, [PII].
[AGENT][NEUTRAL] OK, and you said, I'm sorry, I'm having a hard time hearing you. You said 0188729?
[CUSTOMER][NEUTRAL] No, ma'am. It's [PII].
[AGENT][NEUTRAL] Oh, no. Oh, no, I'm sorry, um, [PII], I meant the policy number.
[CUSTOMER][NEUTRAL] Care
[CUSTOMER][NEUTRAL] Yeah, 01887294 M Mary, L Lima, number 8.
[AGENT][POSITIVE] Thank you very much. OK, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] [PII]. This is a direct line.
[AGENT][POSITIVE] OK, thank you very much. Um.
[AGENT][NEUTRAL] And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bill amount $100.
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] [PII], did you say?
[CUSTOMER][NEUTRAL] Yes, [PII], it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 4 $100. OK, let me really quickly. Thank you.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] For $333 ma'am.
[AGENT][POSITIVE] $333. OK, thank you.
[AGENT][NEUTRAL] The um claim number, [PII] is 35.
[CUSTOMER][NEUTRAL] If
[AGENT][NEUTRAL] 652-57.
[AGENT][NEUTRAL] We received your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received your claim on this.
[AGENT][NEUTRAL] Let's see if I can find it.
[AGENT][NEUTRAL] Sorry, I'm just checking here.
[AGENT][NEGATIVE] She's got a lot of claims.
[AGENT][NEUTRAL] OK, we received your claim on the [PII].
[AGENT][NEUTRAL] We processed it on the [PII].
[AGENT][NEUTRAL] But by that time, all of her outpatient benefits, that's $4000 per calendar year, which is just a verification benefits, I guarantee a payment.
[AGENT][NEUTRAL] All of her calender year benefits had been.
[CUSTOMER][NEUTRAL] No, ma'am, your voice is uh
[CUSTOMER][NEGATIVE] Voice is breaking. I'm not understanding.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we received your your claim on the [PII].
[CUSTOMER][NEUTRAL] Care advocate
[AGENT][NEUTRAL] [PII], we processed it on February the.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But all of her benefits for that calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the calendar year that we're talking about had been exhausted.
[AGENT][NEUTRAL] So she has um $4000 per calendar year as benefits.
[AGENT][NEUTRAL] That's just a verification, not a guarantee of payment, but that all of those benefits have been used for the county year [PII] by the time that we receive this claim.
[AGENT][NEUTRAL] So she'd used all of her calendar year benefits.
[AGENT][NEGATIVE] That's why it was denied.
[CUSTOMER][NEUTRAL] So this is the, so, so the $100 is what, co-pay or deductible of the patient?
[AGENT][NEUTRAL] It would have been the copay and it, and uh we couldn't pay that because she'd already used up the benefits.
[CUSTOMER][NEUTRAL] Copay.
[CUSTOMER][NEUTRAL] So this is
[CUSTOMER][NEUTRAL] co-pay which we can bill to the patient.
[AGENT][NEUTRAL] Well, I can't really tell you that. I mean, she may, I, I can't really tell you that, [PII]. She may have another policy, um, but uh the only thing I can.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Oh, no, ma'am. I'm seriously, I'm not understanding what you are trying to say. You said this is co-pay or the claim is denied for something other reason.
[AGENT][NEUTRAL] No, the, the, the policy is excuse me, the claim was denied because she had used all of her benefits for that calendar year.
[AGENT][NEUTRAL] But I can't tell you.
[AGENT][NEUTRAL] To bill it to the patient because she may have another policy. The only thing I can tell you.
[AGENT][NEUTRAL] Is that we can't pay it.
[CUSTOMER][NEUTRAL] So you mean to say the claim is denied for maximum benefit exhausted?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct. That is correct.