AccountId: 011433970860
ContactId: 523277f2-07b3-4a47-8eaf-76518e4ae181
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 768969 ms
Total Talk Time (AGENT): 206144 ms
Total Talk Time (CUSTOMER): 224407 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/523277f2-07b3-4a47-8eaf-76518e4ae181_20250327T18:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Pro to check an airline status.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] 59
[CUSTOMER][NEUTRAL] 04.
[CUSTOMER][NEUTRAL] Like that.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. The [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII]. It's [PII] and last name is [PII]. It's [PII] and patient date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service?
[CUSTOMER][NEUTRAL] The data service is [PII]. The bill amount is $28 even.
[AGENT][NEUTRAL] $28 even.
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I know your good name, please? Could you spell that?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. How was your day?
[AGENT][POSITIVE] Good, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you said the bill amount was $28 or $29?
[CUSTOMER][NEUTRAL] Yes. It's $28 even. 28.
[AGENT][NEUTRAL] 28. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for the state of service. It was denied the maximum benefit for the state of service had already been met.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Maximum.
[AGENT][NEUTRAL] The maximum benefit for the date of service had already been met.
[CUSTOMER][NEUTRAL] Alre denied.
[AGENT][NEGATIVE] Correct, claim was denied.
[CUSTOMER][NEUTRAL] OK. And the claim is for maximum uh benefits successful, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the received and processed date please.
[AGENT][NEUTRAL] Claim is received [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Claim is processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. You can go ahead with the claim number, please.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Claim number. May I know the claim number, please?
[AGENT][NEUTRAL] 343.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2981.
[CUSTOMER][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the maximum benefit someone for the patient?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The dinner is maximum benefit is, right?
[AGENT][NEUTRAL] Correct. Max benefit payable for the date of service had already been paid. So the outpatient benefit amount was $50 and that was already paid towards that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the, when the maximum benefit is reached?
[AGENT][NEUTRAL] On that date of service, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have another claim for the same patient. Could you please assist me with that?
[AGENT][NEUTRAL] You have another claim?
[CUSTOMER][NEUTRAL] Yes, for the same patient.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] It's [PII] and then billed amount is $79 even.
[CUSTOMER][NEUTRAL] May I know the, before that, may I know the timing for limit for this claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. Could you please share a soft copy of your?
[AGENT][NEUTRAL] One moment, yes.
[CUSTOMER][NEUTRAL] That's what
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] I'll give you a call right now.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] What's the fax number to send the EOB to?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2875.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, EOB is on its way. It should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, go ahead with the non-wire, please.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, this claim was received for $79 on [PII].
[AGENT][NEUTRAL] It was denied and the maximum benefit for the date of service had already been met. The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, claim number, please.
[AGENT][NEUTRAL] 344-365-5
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] The amount is?
[AGENT][NEUTRAL] It was the same as the previous, it was the $50 allowed amount.
[CUSTOMER][NEUTRAL] OK, the same.
[AGENT][NEUTRAL] Met on that same data service 22 22924.
[CUSTOMER][NEUTRAL] That same day as it is.
[CUSTOMER][POSITIVE] OK no worries.
[CUSTOMER][NEUTRAL] Could you please share the so copy of UOB, please?
[AGENT][NEUTRAL] Mhm. Absolutely. Same fax number?
[CUSTOMER][NEUTRAL] Yes, same fection, but
[AGENT][NEUTRAL] OK, I'm sending that now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sorry, anything else I can check on for you?
[CUSTOMER][POSITIVE] Yes, I have another time for you suggest.
[AGENT][NEUTRAL] Different patient?
[CUSTOMER][NEUTRAL] I have another claim for the same patient.
[AGENT][NEUTRAL] OK, um, is it the same patient or a different one?
[CUSTOMER][NEUTRAL] The same patient.
[AGENT][NEUTRAL] OK, one moment, let me just send the COB to you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] The data services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And bill amount is 2 to 1. It's $221 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, patient's policy does not provide any benefits for inpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, same didn't, yes.
[AGENT][NEUTRAL] Not covered under the policy, correct.
[CUSTOMER][NEUTRAL] Its masume benefits on data service is the same reason or a different decision?
[AGENT][NEUTRAL] No, it's a different reason. The policy does not provide any benefits for the charges for inpatient visit.
[CUSTOMER][NEUTRAL] For the previous.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] How does not provide for the patient.
[CUSTOMER][NEUTRAL] The policy is not covered, right?
[AGENT][NEUTRAL] It's not covered under the member's policy, correct.
[CUSTOMER][NEUTRAL] And the, the numbers phone number, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] May I know the, may I know when, when the letter initially, when the letter was sent to the patient?
[AGENT][NEUTRAL] When what was sent to the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I apologize, [PII]. Ask your question again. What was sent to the patient? What are you asking?
[CUSTOMER][NEUTRAL] May I know when the letter was sent to the patient?
[AGENT][NEUTRAL] It would have been sent on the denial date of [PII].
[CUSTOMER][NEUTRAL] OK, one moment. The letter was in.
[CUSTOMER][NEUTRAL] On the date.
[CUSTOMER][NEUTRAL] If you need yes response from the patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] No response. OK.
[CUSTOMER][NEUTRAL] Could you please send me a claim for reprocess?
[AGENT][NEUTRAL] There's nothing to reprocess. The patient's plan doesn't cover the charges sent.
[CUSTOMER][NEUTRAL] OK. May I know the claim number, please?
[AGENT][NEUTRAL] 343-738-4
[CUSTOMER][NEUTRAL] OK. Thank you for your information. May I know the contact number, please?
[AGENT][NEUTRAL] Call references my name with my last initials in today's date.
[CUSTOMER][NEUTRAL] Your [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you for the information, [PII]. Thank you. Have a good day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.