AccountId: 011433970860
ContactId: 1b0ad631-4e51-47fd-b956-60d51667a478
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305359 ms
Total Talk Time (AGENT): 119405 ms
Total Talk Time (CUSTOMER): 134750 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/1b0ad631-4e51-47fd-b956-60d51667a478_20250211T17:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] here, calling from provider office to know the claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. Um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct number.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 025 025554
[AGENT][NEUTRAL] All right, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that, [PII]. And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that bill them out please.
[CUSTOMER][NEUTRAL] $3,782 even.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] [PII], what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] It's HCA Florida Institute for Women's Health.
[AGENT][NEUTRAL] OK, thank you so we did receive this claim, uh, we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK. May I know the received date?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Uh, we received this claim [PII], and it was processed to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And ma'am, uh, benefit, uh, maximum has been reached. So, may I know, it has been reached as per uh terms value, dollar value, or as per patient visit?
[AGENT][NEUTRAL] It was a dollar value had been met for the year.
[CUSTOMER][NEUTRAL] OK. Uh, as per dollar value.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So we can build this to patients, right?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] So is this a patient responsibility or is this a uh adjustment as per UB?
[AGENT][NEUTRAL] We do not say, we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Uh, no problem, but as per you be, uh, uh, it is stating to build the patient responsibilities. So I'm just verifying. I, I have just called to verify the same.
[AGENT][NEUTRAL] I can send you a copy of [PII]'s mic do not state anything to do with patient responsibility.
[CUSTOMER][NEUTRAL] Please, uh, please let me know, uh, yeah, shall I tell you the fax number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's just a moment, please.
[CUSTOMER][NEUTRAL] OK, just a moment, OK.
[CUSTOMER][NEUTRAL] So as a
[CUSTOMER][NEUTRAL] Protocol, if dollar value, then we can bill it to patients. Still, I will give you the fax number which is [PII].
[AGENT][NEUTRAL] OK, I will send you this EOB um we were simply unable to pay a benefit, but again we do not say what is patient responsibility.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, and may I know uh allowed and uh
[CUSTOMER][NEUTRAL] Allowed amount?
[AGENT][NEUTRAL] Uh, their total, uh, outpatient benefit?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Their do you mean their outpatient benefit amount?
[CUSTOMER][NEUTRAL] No, no, the, the, the allowed amount like uh paid 0 and uh there would be some allowed amount, right?
[CUSTOMER][NEUTRAL] So many
[AGENT][NEUTRAL] So they had just met their maximum so we were unable to pay anything additional. The total outpatient benefit is $2500 per calendar year and we had paid that previously to this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 3500 was the limit, right?
[AGENT][NEUTRAL] 2500 was the limit.
[CUSTOMER][NEUTRAL] OK, 2500.
[CUSTOMER][POSITIVE] Thank you, ma'am. And um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what will be the turnaround turnaround time to get the fax?
[AGENT][NEUTRAL] I'm sending it to you right now. Um, you should get it here in maybe 10-15 minutes depending on how busy your machine is.
[CUSTOMER][NEUTRAL] Sure. And uh the claim number?
[AGENT][NEUTRAL] Claim number is 3556942.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could do to help [PII]?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] No, ma'am. Thank you for your kind assistance.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, thanks for calling A. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye-bye.