AccountId: 011433970860
ContactId: 5e30ca77-b617-4ed5-ac6d-96289e9354c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301970 ms
Total Talk Time (AGENT): 111602 ms
Total Talk Time (CUSTOMER): 131012 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/5e30ca77-b617-4ed5-ac6d-96289e9354c3_20250502T21:19_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is uh calling from provider's office to check on a claim status. And could you please spell out your name please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. It's [PII] last initial [PII] and your name is again? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] For the policy ID is, uh, just one moment.
[CUSTOMER][NEUTRAL] Insurance, 01650821.
[AGENT][NEUTRAL] OK, thank you one moment and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] My contact number is [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The service is uh [PII] entered on the same day, [PII]. And the bill charges are $2630 even.
[AGENT][NEUTRAL] OK, and what is the balance after Primary has processed the claim?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] The claim paid amount for the uh for the, sorry.
[CUSTOMER][NEUTRAL] The primary deductible process amount is $713.01.
[AGENT][NEUTRAL] No, sir. I'm asking the balance after the primary insurance has processed the claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, $2630 minus 7131 cents.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's a $1,916.99.
[AGENT][NEUTRAL] OK, a moment, and while I'm looking up claim information let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII]. And what is the name of the doctor's office or the facility you're calling from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The provider's name is.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Provider's name is Five Oaks Medical Group.
[AGENT][NEUTRAL] OK, thank you. I'm showing that claim processed as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK. May I know when it was declined?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, sure, the claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK. And you say the climbers deny it, right?
[AGENT][NEUTRAL] Yes, as the outpatient benefits of Max for the calendar year.
[CUSTOMER][NEUTRAL] OK. The maximum benefit is exhausted for the patient. May I know, uh, is it, or do you need a dollar, which one is the patient is make?
[AGENT][NEUTRAL] The dollar value.
[CUSTOMER][NEUTRAL] $0 value. How much is the $1?
[AGENT][NEUTRAL] Insur had has an outpatient benefit up to 1000 per calendar year, and they've already met it for 2024.
[CUSTOMER][NEUTRAL] Outpatient, OK.
[CUSTOMER][NEUTRAL] Patient already met.
[CUSTOMER][NEUTRAL] [PII]. And I have one more question. Do you have the patient lomid date?
[AGENT][NEUTRAL] I do, but I can't give you that information since it's not in regards to a claim you're inquiring about.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Could you please spell the claim number?
[AGENT][NEUTRAL] Uh, this claim was 357-536-1.
[CUSTOMER][NEUTRAL] Sorry, could you be slowly?
[AGENT][NEUTRAL] 357-536-1.
[CUSTOMER][NEUTRAL] 357-536-1, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Oh, that's great. And
[CUSTOMER][NEUTRAL] Could you please provide the reference number?
[AGENT][NEUTRAL] Uh, you may use my name in today's date if you like.
[CUSTOMER][NEUTRAL] Yeah, OK. Thank you, thank you for help. And I need the denial, you'll be could be through fax.
[AGENT][NEUTRAL] As I stated, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much. Thank you. Have a great day. Bye.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL bye.