AccountId: 011433970860
ContactId: 68ff227f-f90d-4426-861d-e3c0779786dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569080 ms
Total Talk Time (AGENT): 111232 ms
Total Talk Time (CUSTOMER): 159628 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/68ff227f-f90d-4426-861d-e3c0779786dd_20250211T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling to check for the no clarification today.
[AGENT][NEUTRAL] Um, you're trying to check on, um, I, I'm sorry, we need clarification of denial, is that what you said?
[CUSTOMER][NEUTRAL] Yeah, uh, for medical claim, the clarification.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yeah, I can check that claim for you. uh, [PII], if you don't mind, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, of course, just one moment, let me just provide the callback number.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So the callback number is gonna be [PII]. That's with the extension [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you for that and then uh do you have the policy number?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy number for the number is 022854771.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] So the first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then did you have a claim number?
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number which I have on my end is 3305582.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And that was from uh Prisma Health.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, one moment please.
[AGENT][NEUTRAL] OK, so for this claim, [PII], it does state that the anesthesia benefits are based on the benefits allowable under their surgical benefit. So for this claim to be considered, we do have to have the surgical charges for the date of service so that both of the benefits can be considered.
[CUSTOMER][NEUTRAL] So we are requesting for the medical reports for the charges we built.
[AGENT][NEUTRAL] For the surgery, yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And I just wanna know, we have already sent.
[CUSTOMER][NEUTRAL] The records on [PII]. No, we have previously submitted records on [PII] regarding this issue. So I just wanna know if you guys received any on that.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] OK, yeah, give me just a moment, let me take a look.
[CUSTOMER][POSITIVE] Yeah, of course. Please take it down.
[AGENT][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK. I think I might have found it, [PII], are you still there?
[CUSTOMER][NEUTRAL] Yeah, I'm still here.
[AGENT][NEUTRAL] OK, um, so I think we did if this is what I'm seeing this was for the data service of [PII], right?
[CUSTOMER][NEUTRAL] Yeah, that's right. Uh, when did you guys receive the records?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]. So that looks like that was [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, could you please tell me whether this claim to be processed for payment after receiving the medical records because we haven't received any other updates.
[AGENT][NEGATIVE] I can send you this EOB absolutely. um, it does state that we were unable to pay a benefit as the anesthesia benefit uh was exhausted.
[AGENT][NEUTRAL] For the date of service.
[AGENT][NEUTRAL] Did you have a fax number I could send this to, [PII]?
[CUSTOMER][NEUTRAL] So the anesthesia benefits as it's all for this patient for this particular date of service.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But uh we have received a payment for another bill amount we provided we built for the same patient.
[AGENT][NEUTRAL] Could you repeat that, [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] So, we have received a payment from you guys for another bill amount for the same service.
[CUSTOMER][NEUTRAL] Same date, sorry, same service, same patient. We have received a payment on that. That is also an anesthesia service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have that claim number?
[CUSTOMER][NEUTRAL] Yeah, just one moment.
[CUSTOMER][NEUTRAL] So that claim number is gonna be
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 333-724-9
[AGENT][NEUTRAL] Um, OK, give me one moment.
[AGENT][NEUTRAL] OK, yes, so that did meet the maximum I'm sorry, it looks like I was looking at a duplicate.
[CUSTOMER][NEUTRAL] So for one date of service you guys would pay for only one provider for anesthesia service.
[AGENT][NEUTRAL] It's for the one date of service, yes.
[AGENT][NEUTRAL] It goes off of a percentage for whatever particular surgery that they had.
[CUSTOMER][NEUTRAL] But this is for a different vending provider, right? So it is not the same vending provider which is being built.
[CUSTOMER][NEUTRAL] And uh we also haven't received the EOB for this particular denial mentioning claim is denied for this reason.
[CUSTOMER][NEGATIVE] I have not received an EOP.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, uh, are you still there?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, sir. Are you still there?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?