AccountId: 011433970860
ContactId: 39cd42d9-c637-4f9b-8b2c-81ce05637dd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 932719 ms
Total Talk Time (AGENT): 236005 ms
Total Talk Time (CUSTOMER): 228026 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/39cd42d9-c637-4f9b-8b2c-81ce05637dd0_20250611T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], you're calling from the office to check on claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get your name one more time, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Before we proceed, I'll let you know this call will be recorded for quality and training purpose, and the callback number is [PII] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 025578885
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, give me just one moment to look that up.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] and build amount is $1,079 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII]. It was processed on the same day.
[AGENT][NEUTRAL] Let me see here real quick.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like we paid $595.30.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] It looks like we paid that claim.
[AGENT][NEUTRAL] In the amount of 500.
[CUSTOMER][NEUTRAL] Yeah, I took [PII].
[AGENT][NEUTRAL] Go ahead, what?
[CUSTOMER][POSITIVE] Yeah, actually clean good dinner for the, yeah, actually clean good dinner for the primary so we already send the primary will be on [PII]. So now I want to know the status of that.
[AGENT][NEUTRAL] Give me just one second.
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] And you said you sent in.
[AGENT][NEUTRAL] Uh, the primary EOB, when did you send that in?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] What was the provider's name?
[AGENT][NEUTRAL] For the hospital name?
[CUSTOMER][NEUTRAL] You're asking for the rendering provider. Yeah, it's [PII]. It's the rendering provider name.
[AGENT][NEUTRAL] I'm sorry, what was the provider's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The total bill amount was $1,079.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And that is for a different date of service.
[CUSTOMER][NEUTRAL] No, this is uh for [PII] bill amount is $1,079.
[CUSTOMER][NEUTRAL] And also it's a split payment. There is also a 2,764.
[CUSTOMER][NEUTRAL] For 1 73 2025.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, and for the claim that was for the date of service.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Actually, it's a split.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Yeah, actually it's a split bill claim. Yeah, actually it's a split build claim.
[CUSTOMER][NEUTRAL] They, they are, uh, same data service for two different amounts. First is 2,764 and the second one is 1,079.
[CUSTOMER][NEUTRAL] So, 2 for 2,7764. So we got the payment on that bill amount. So we just require for the status of 1,079.
[AGENT][NEUTRAL] What was the first one?
[AGENT][NEUTRAL] Yes, and for that payment, it looks like we paid for that um portion, it looks like we paid $595.30.
[AGENT][NEUTRAL] For that portion.
[CUSTOMER][NEUTRAL] Uh, OK. So could you please confirm, uh, for the security code [PII], 1st line security code [PII]. What is the paid amount?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] For first line CPT code which is 76816. Could you please provide me the paid amount?
[AGENT][NEUTRAL] We paid $344.43.
[CUSTOMER][NEUTRAL] And for second line CPT code 76816 with 59 modifier paid amount.
[AGENT][NEUTRAL] The the same amount, $344.43.
[CUSTOMER][NEUTRAL] And for code 76816?
[CUSTOMER][NEUTRAL] 776817.
[AGENT][NEUTRAL] $321.
[AGENT][POSITIVE] Oh, that one, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, now we are including
[AGENT][NEUTRAL] Oh, hold on, give me one moment. Um, I'm so sorry, 4 76816.
[AGENT][NEUTRAL] We paid the $344.43 for that 2nd 1, 76816, we only paid $250.87. I'm sorry.
[CUSTOMER][NEUTRAL] 25,080, correct?
[AGENT][NEUTRAL] 250 and 87 cents. So 87.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And for third line security code which is [PII]?
[AGENT][NEGATIVE] Uh, that one was denied.
[CUSTOMER][NEUTRAL] OK, so could you please confirm the denial reason for 768167.
[AGENT][NEUTRAL] It looks like they, uh, the outpatient benefit for that calendar year was met, so they met their maximum.
[CUSTOMER][NEUTRAL] OK, so for security code [PII], uh, claim got denied for the max benefit.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so in terms of amount or units or what?
[AGENT][NEUTRAL] Um, what was the total amount?
[CUSTOMER][NEUTRAL] OK, so in terms of amount, so how much amount is uh uh paid or?
[AGENT][NEUTRAL] The $595.30 was the total for the two that got.
[CUSTOMER][NEUTRAL] So how much amount is allowed for this code?
[AGENT][NEUTRAL] It'd be a [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And how much amount is paid yet?
[AGENT][NEUTRAL] Are you wanting to know their benefit maximum?
[CUSTOMER][NEUTRAL] Yes, so this is the allow amount. So how much amount is paid and when and when was the last benefit was exhausted?
[AGENT][NEUTRAL] Let me pull that up.
[AGENT][NEGATIVE] The last benefit that was exhausted was in that last claim, uh, when we paid $250 for procedure 76816. That was when they exhausted the rest of their benefits.
[CUSTOMER][NEUTRAL] On the same date of service.
[AGENT][NEUTRAL] Yes, for the same date of service.
[CUSTOMER][NEUTRAL] But both the CPT codes are different.
[CUSTOMER][NEUTRAL] And how it's possible that in 76816 benefit has been exhausted.
[AGENT][NEUTRAL] Because it goes by their outpatient benefit maximum, they're all combined. So once they've reached their outpatient maximum, uh, the claim is going to be denied because they met their maximum.
[AGENT][NEUTRAL] It's not by procedure code.
[CUSTOMER][NEUTRAL] OK. And under which plan?
[CUSTOMER][NEUTRAL] Is there any plan name?
[AGENT][NEUTRAL] It's under their Medlink policy.
[CUSTOMER][NEUTRAL] Mm, could you please spell out uh M E D A, correct?
[AGENT][NEUTRAL] M E D L I.
[AGENT][NEUTRAL] N K.
[CUSTOMER][NEUTRAL] OK, mail link for this.
[CUSTOMER][POSITIVE] Um, OK, thank you so much. Could you please provide the card number I need the name.
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date. So [PII] in today's date.
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Uh, could you spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, uh, yeah, could you please, uh, send me the paid UV via fax to [PII].
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Where did I get that.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And who does, who does the attention need to go to?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and to confirm, I have [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I just sent that fax over. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, how much time it will take to this year?
[AGENT][NEUTRAL] Uh, it shouldn't take more than, um, an hour.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. Thank you so much. Uh that's from my side. You are very helpful. Have a great day. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.