AccountId: 011433970860
ContactId: 171ea9f1-b55d-4773-827f-88c99e29ff41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368799 ms
Total Talk Time (AGENT): 84624 ms
Total Talk Time (CUSTOMER): 124102 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/171ea9f1-b55d-4773-827f-88c99e29ff41_20250127T18:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, sir. My name is [PII]. Last name initial is [PII]. Can you help me with the claim, please?
[AGENT][NEUTRAL] Yeah, I'm happy to check on a claim, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02049543.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Alright, one moment, let me just pull this up. Do you have a good call back number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] First name will be [PII], last name will be
[CUSTOMER][NEUTRAL] [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] Thank you and the service?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] It will be [PII] and the bill amount is going to be, let me open that up.
[CUSTOMER][NEUTRAL] $369.25.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a bill amount after the primary Oscar?
[CUSTOMER][NEUTRAL] It is, uh, let me just.
[CUSTOMER][NEUTRAL] Just a second. It will be, let me calculate it.
[CUSTOMER][NEUTRAL] It is $61.85.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I have a claim on file that data service. The bill amount was for 337.53 though.
[CUSTOMER][NEUTRAL] Is it paid for $7.69?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, that's the claim.
[AGENT][NEUTRAL] OK. So it looks like.
[AGENT][NEUTRAL] On this claim, the paid amount of the $7 that was a maximum benefit, uh, it looks like with that payment they had met their max for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] So there was nothing additional payable.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just a second, let me check the previous billing if there is any information on that.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] I'm gonna check the previous data service which has been built.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] To see if there's any information regarding.
[CUSTOMER][NEUTRAL] Um, do you have the primary OB with you?
[AGENT][NEUTRAL] Uh, let me take a look, one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like we don't have a primary EOB. It looks like we just got a claim form and then a bill itemized.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Like I just checked and found that the primary actually paid on the claim. So do I just submit the primary will be with the claim again to you guys so you can identify and reissue the payment for the line item that has been denied.
[CUSTOMER][NEUTRAL] Because without the primary of the insurance won't pay.
[AGENT][NEUTRAL] Correct. However, the patients already met their calendar year max, so nothing additional would be payable. The plan only pays out a max of 4500, so the 769 exhausted the benefit for the year.
[CUSTOMER][NEUTRAL] But uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so for the year insurance only pays 4500 on any game like for the year, right?
[AGENT][POSITIVE] Correct, and they had already used that full amount for the year once this data service arrived.
[CUSTOMER][NEUTRAL] OK, like it's really hard to calculate for me to like.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just a second please.
[CUSTOMER][NEUTRAL] Just a moment please, can you hold on a second, [PII]?
[AGENT][NEUTRAL] Yeah, I can hold for a moment.
[CUSTOMER][NEUTRAL] Yeah