AccountId: 011433970860
ContactId: 57c7df41-34f1-4a74-a4a6-6f793b8bfd46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360799 ms
Total Talk Time (AGENT): 106932 ms
Total Talk Time (CUSTOMER): 129997 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/57c7df41-34f1-4a74-a4a6-6f793b8bfd46_20250429T16:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], my last name [PII] calling from provider's office to check on claim status. Could you please help us?
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you. What's the patient's policy number, please?
[CUSTOMER][NEUTRAL] 02558899.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. May I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name, [PII], last name [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and the bills amount?
[CUSTOMER][NEUTRAL] $1280 even.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And we did receive a claim for the state of service. claim was received on [PII].
[CUSTOMER][NEUTRAL] Let me send you a claim for the date of service.
[AGENT][NEUTRAL] Claim is processed and denied [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The maximum benefit for the state of service had already been met.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The claim was denied as maximum benefits of the member's plan was met, right?
[AGENT][NEUTRAL] For the data service, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, ma'am, upon checking in our site, we didn't bill any other claim on the same date of service.
[CUSTOMER][NEUTRAL] This is the only plane we built. Could you please check with that?
[AGENT][NEUTRAL] So there was another claim for date of service, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was for Kinstone Hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wellstar Kinston Hospital, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Yeah, ma'am. But that, uh,
[CUSTOMER][NEUTRAL] I'm calling about the claim only.
[CUSTOMER][NEUTRAL] We have only one claim on file. We don't have any other claim to build the member.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The patient was seen by a different provider on that date, therefore,
[AGENT][NEUTRAL] The maximum benefit was paid out.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's why the claim for your facility was denied.
[CUSTOMER][NEUTRAL] OK. That, uh, for this member, for same date of service but different provider, the claim was billed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, it was paid
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, ma'am, uh, since it was a different provider, could you please take the process this claim?
[AGENT][NEUTRAL] Can I please check the what?
[CUSTOMER][NEUTRAL] Uh, it was under a different provider, right? From our side, we didn't be any other claim. Could you take, uh, reprocess the claim?
[AGENT][NEUTRAL] No, ma'am, because the patient's plan only allows for one benefit per date of service.
[AGENT][NEUTRAL] So there's nothing else additional payable for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] May I know the reconsideration mailing address, ma'am?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] May I know the timely filing limit to submit and reconsideration?
[AGENT][NEUTRAL] Any sort of appeal needs to be filed within 180 days of the process date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much, ma'am. Uh, could you please spell out your name for documentation purpose?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] Can you just your last name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much, ma'am. Can I get a call reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date.
[CUSTOMER][NEUTRAL] my.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you so much, ma'am. Thank you for assisting. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You too, bye bye.