AccountId: 011433970860
ContactId: 4167d891-dc1a-4e7f-ae05-54e4c09cd502
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 847440 ms
Total Talk Time (AGENT): 287396 ms
Total Talk Time (CUSTOMER): 239501 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/4167d891-dc1a-4e7f-ae05-54e4c09cd502_20250221T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Pro office to check on the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. I didn't get your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII].
[AGENT][NEUTRAL] [PII], OK, and may I have a callback number just in case we get disconnected with [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, sure, my callback number is [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient policy number is
[CUSTOMER][NEUTRAL] 02321036
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, sure. The patient name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK perfect thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is [PII].
[AGENT][NEUTRAL] OK, and how much is the total charge of the claim?
[CUSTOMER][NEUTRAL] Uh, the total charge amount is.
[CUSTOMER][NEUTRAL] $800 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and that's [PII] for 800, correct?
[CUSTOMER][NEUTRAL] Yes, [PII], uh sorry, [PII], [PII]. The total charge amount is $800 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and for future, you can check claim status online through our website at [PII] and that's just optional and let me go ahead and pull the EOB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, OK, so it looks like it was processed twice, um, so I'm gonna go ahead and give you the information of the original claim because the last one was processed as a duplicate, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so the original claim, let me see when we received this, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That is 1 to 5 I think.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] And this is for Southeast Medical Group?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII], process [PII], and we send a benefit amount of $25 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like with the payment of that check, the maximum benefit has been exhausted for the date of service.
[CUSTOMER][NEUTRAL] You mean the claim was received on [PII]?
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Processed it on [PII], right?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] They know the claim was paid or denied.
[AGENT][NEUTRAL] We send a benefit amount of $25 to the provider.
[CUSTOMER][NEUTRAL] Only $25 amount to be paid, right?
[AGENT][NEUTRAL] Correct, that's the amount that was sent with the payment of that check, the maximum benefit has been exhausted.
[AGENT][NEUTRAL] For the year.
[CUSTOMER][NEUTRAL] May I know the CPT code 95,800, please?
[CUSTOMER][NEUTRAL] These two twice build the same CPTs on the same time.
[AGENT][NEUTRAL] OK, you said what is the CPT code that you're looking for?
[CUSTOMER][NEUTRAL] 95,800
[AGENT][NEUTRAL] OK, yeah, one of them.
[CUSTOMER][NEUTRAL] The total bill amount is for of the CPT code.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, uh $25 is the maximum benefit. We did pay the maximum benefit and with that payment, the maximum has been exhausted. So we have paid just one of them because uh $25 was uh just for one of them, OK?
[CUSTOMER][NEUTRAL] OK, you mentioned the CPT code 95,800 was paid, maximum amount was exited, correct? So that you paid only $25 for the CPT code, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that information. Uh, may I know the annual allowed amount for this?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] CT
[AGENT][NEUTRAL] OK, let me check and see. One moment. And this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that is uh $25.01 time per cover person per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The CPT covers only $25 as per as per one year, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, it's $25 once per year.
[CUSTOMER][NEUTRAL] OK, for the CPT code 95,800, right?
[AGENT][NEUTRAL] For any, for any charges for that, for a diagnostic follow-up. That is for a diagnostic follow-up.
[CUSTOMER][NEUTRAL] You mentioned this 95,800 was a allowed amount, please, can I get the allowed amount for the security code?
[AGENT][NEUTRAL] Again, it's not really based on CPT code, uh, even though we pay for that CPT code because the only benefit that the policy has is the $25. So the $25 was paid against that CPT code of 95,800, but that one is for any follow up diagnostic test. So that is the benefit amount, that is the maximum benefit, and that's the amount that we paid and that will be the maximum for the calendar year. So there's no other benefits for this year for that type of service.
[CUSTOMER][NEUTRAL] OK, you mentioned there is uh only one CPT. You pay maximum amount that is $25 to be paid. So, uh, uh, another one that is fine with $50 to modify you not paid because the maximum unit was exceeded, right, as per the year.
[AGENT][POSITIVE] The maximum benefit, yeah, correct, yes, that is correct.
[CUSTOMER][NEUTRAL] Thank you so much for that information. May I know the, uh, the calendar. May I know the last visit date, please? That is, um, can I is is in January to December or any benefit here, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] That is, that is.
[AGENT][NEUTRAL] Again, Miss [PII], that is the one time benefit. So you got the one time benefit, so it's your claim.
[CUSTOMER][POSITIVE] OK, thank you so much for the information. May I know the claim number, please? What's your claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim number is 3436725.
[CUSTOMER][POSITIVE] Yes, thank you so much. May I know the call reference number, please?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We don't have a reference number so you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much, sir, on today's date, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] Yes, thank you so much, sir. That's for now. Thanks for asking. Have a great day. And before that, may I know the pay details, please?
[AGENT][NEUTRAL] I'm sorry, can you repeat? You cut off.
[CUSTOMER][NEUTRAL] May I know the details you pay $25 right?
[AGENT][NEUTRAL] Yeah, it was $25 and it was a check, a single check paper check.
[AGENT][NEUTRAL] Do you need the check number?
[CUSTOMER][POSITIVE] Thank you so much. May I know check number, please? Yes.
[AGENT][NEUTRAL] Mhm. That is 1843538.
[CUSTOMER][POSITIVE] Thank you so much. It's a bulk amount or single amount?
[AGENT][NEUTRAL] Single amount.
[CUSTOMER][POSITIVE] Thank you so much for that information. May I know the cash date, please?
[AGENT][NEUTRAL] OK, I will have to
[CUSTOMER][NEUTRAL] And issued it
[AGENT][NEUTRAL] OK, I will have to review and see if we have a cash date. OK, so if you don't mind holding for me, I can get this information for you, OK?
[CUSTOMER][POSITIVE] OK, sure. Please take your time.
[AGENT][POSITIVE] Thank you. Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Miss [PII]. OK, it looks like the check clear [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know the issue date, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, thank you so much for that information. Could you please verify that pay to address?
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] Yes, thank you so much for confirming. Uh, that's for now. Thanks for asking.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome and thank you for.
[CUSTOMER][POSITIVE] And before that, may I know, yes, thank you for assisting. Have a great day and bye and happy weekend.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's fine now. Thanks for asking.
[AGENT][POSITIVE] OK. You're welcome. Have a good day. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] Uh, yes, um, before that, I, could you have forgot to ask one thing. Could you please send a copy of your be through fax?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] OK. Bear with me just a second, let me send this out. One moment.
[CUSTOMER][NEUTRAL] OK. Mhm. OK.
[AGENT][NEUTRAL] Is it gonna be to your attention, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, attention to my name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said the fax number is [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I have sent that information. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] And before that, when I can get the copy of your P within days or
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] No, it's gonna be in a few minutes.
[CUSTOMER][POSITIVE] OK, thank you so much for that information. That's for now. Thanks for listening. Have a great day and bye.
[AGENT][NEUTRAL] Bye-bye.