AccountId: 011433970860
ContactId: 73bfd486-64c8-4f10-a49e-4b850007e7f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 146270 ms
Total Talk Time (AGENT): 45911 ms
Total Talk Time (CUSTOMER): 52855 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/73bfd486-64c8-4f10-a49e-4b850007e7f2_20250528T20:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from provider's office and uh I'm looking for claim denial discussion.
[AGENT][NEUTRAL] Alright, what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Sure. Hold on a moment, please.
[CUSTOMER][NEUTRAL] Please note down. Uh 016.
[CUSTOMER][NEUTRAL] 331
[CUSTOMER][NEUTRAL] 80.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And date of service?
[CUSTOMER][NEUTRAL] [PII] or [PII], sorry.
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] $458.57.
[AGENT][NEUTRAL] So we did receive this claim on [PII]. Claim was denied [PII].
[AGENT][NEUTRAL] Uh, the patient plans outpatient benefit max had been met.
[AGENT][NEUTRAL] For the year.
[CUSTOMER][NEUTRAL] OK, so can we bill this amount to the patient?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so plan, uh, the maximum benefit for outpatients, uh, either has been uh exhausted.
[AGENT][POSITIVE] Correct. Uh-huh.
[CUSTOMER][NEUTRAL] For the calendar year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for call reference number, please.
[AGENT][NEUTRAL] Uh call reference is my name with today's date. My name is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] 2 days. Thank you so much, [PII]. Have a great day.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye.