AccountId: 011433970860
ContactId: 74635a77-803e-4153-9cda-10a5ea8d24cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 779039 ms
Total Talk Time (AGENT): 236677 ms
Total Talk Time (CUSTOMER): 209763 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/74635a77-803e-4153-9cda-10a5ea8d24cc_20250515T17:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from provider office to check on client status.
[AGENT][NEUTRAL] I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII]. There is my extension is a direct line.
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, the ID number is 02275146.
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And uh, may I know your good name, please?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you tell me the name one more time?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Oh, I'm sorry, the name of the patient.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] Date of birth of the patient is [PII].
[AGENT][NEUTRAL] OK, yes ma'am.
[CUSTOMER][POSITIVE] Thank you for calling.
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Yes, I have the claim number.
[CUSTOMER][NEUTRAL] I, uh, date of service is on [PII].
[CUSTOMER][NEUTRAL] The client number I have here is 346-481-6.
[AGENT][NEUTRAL] 346-481-6
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like we received that claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I need the Dao B.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know your name?
[AGENT][NEUTRAL] And it looks like that
[AGENT][NEUTRAL] That claim was denied because the benefit maximum for that date of service has been met.
[CUSTOMER][NEUTRAL] Maximum benefits is reached, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I know the CBD code.
[CUSTOMER][NEUTRAL] The 99213, right?
[AGENT][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] 99213 yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How many visits allowed for the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] How many visits is she allowed?
[AGENT][NEUTRAL] Is that what you're asking? OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look that up.
[CUSTOMER][NEUTRAL] Echo Yankee.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] I know your name?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] 1 [PII].
[AGENT][NEUTRAL] It looks like she had a she has a maximum for that particular benefit of $75. Now that is a verification of benefits and not necessarily a guarantee of payment. That claim was denied due to her having already met her maximum for that day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the received date of this claim?
[CUSTOMER][POSITIVE] Thank you for calling Blue Car.
[AGENT][NEUTRAL] I'm sorry, there's some static going on. You need the date of what?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, uh, may I know the received date?
[AGENT][NEUTRAL] Oh, the received date, yes, ma'am.
[CUSTOMER][NEUTRAL] May I know the received date?
[AGENT][NEUTRAL] It looks like we received it on June.
[AGENT][NEUTRAL] Yeah, the received date was [PII].
[CUSTOMER][NEUTRAL] OK. May I know the date?
[AGENT][NEUTRAL] It would be the same day.
[CUSTOMER][NEUTRAL] Remember I start with the letter.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] ID.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][POSITIVE] Maximum um benefits is met.
[AGENT][NEUTRAL] For that day, yes, ma'am.
[CUSTOMER][NEUTRAL] In terms of, in terms of dollar amount, right?
[AGENT][NEUTRAL] Right, her maximum benefit for that date of service was met, and that's why the claim was denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The dollar amount, uh, how much, how much is the dollar amount as per the benefits?
[AGENT][NEUTRAL] Uh, she was allotted $75 up to $75.
[AGENT][NEUTRAL] And that might not have been for this claim, but that is what her policy allows.
[CUSTOMER][NEUTRAL] $75. OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] They allowed per calendar year, right?
[AGENT][NEUTRAL] Um, I'm double checking that for you.
[CUSTOMER][NEUTRAL] $75 is salad for.
[AGENT][NEUTRAL] I'm double checking on that for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, $75 per day per calendar year, with a maximum of 6 days per calendar year.
[CUSTOMER][NEUTRAL] $75 were allowed per calendar year, right?
[AGENT][NEUTRAL] Per day, per calendar year. So she is allotted 75 up to $75 per day with a maximum of 6 days per calendar year.
[CUSTOMER][NEUTRAL] OK. 75 $75 per day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We allowed the calendar year.
[CUSTOMER][NEUTRAL] Maximum of 66 inches per day, right?
[AGENT][POSITIVE] Correct for the calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Sorry, 75, uh, it is in the dollar amount, so it is $75 per day were allowed per calendar year. The maximum is it met uh maximum dollar is met on?
[AGENT][NEUTRAL] Yes, that's why the claim was denied, the maximum for that day that she was seen.
[AGENT][NEUTRAL] Had been met already.
[CUSTOMER][NEUTRAL] May I know the date? May I know the last date when, when she met.
[AGENT][NEUTRAL] I do not have that.
[CUSTOMER][NEUTRAL] OK, then now you're saying it is met.
[AGENT][NEUTRAL] Yes, for that date of service, that $75 maximum was met already. I do not know when it was met.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. May I know the last day?
[CUSTOMER][NEUTRAL] May I know the last date of service?
[AGENT][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] It's what I'm showing.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Can you able to request the uh denial through a fax?
[AGENT][NEUTRAL] I can see where it was sent. Give me one second.
[AGENT][NEUTRAL] It would have been sent to Alpha Medical Center.
[AGENT][NEUTRAL] And let me see the
[CUSTOMER][NEUTRAL] Yes, it is sent, uh.
[CUSTOMER][NEUTRAL] Can you able to send through our fax?
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Oh, I, I know. Give me just one moment. I'm trying to see where we sent it to to verify that we do have the correct address as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Where to go.
[CUSTOMER][NEUTRAL] 850.
[CUSTOMER][NEUTRAL] 91,450.
[AGENT][NEGATIVE] Give me just one second, my computer is going a little bit slow.
[CUSTOMER][NEUTRAL] You may experience a few seconds of silence.
[AGENT][NEUTRAL] Yes, it was sent to [PII], and you're saying you would like that explanation of benefits mailed to or faxed instead?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] I need the denial, yes, I need the denial EB through our fax. I have the fax number. Shall I proceed with it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. What's the fax number?
[CUSTOMER][NEUTRAL] It's still
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Let me read that back to make sure I have it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] I will get that faxed over to you.
[AGENT][POSITIVE] You should receive it in a couple of minutes.
[CUSTOMER][NEUTRAL] OK. May I have the claim number?
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] 346.
[AGENT][NEUTRAL] 4816.
[CUSTOMER][NEUTRAL] 346-4816. May I have the call reference number?
[AGENT][NEUTRAL] We don't have a call reference number, but you can use my name and last initial, so [PII].
[AGENT][POSITIVE] And then today's date. Mhm thank you so much for calling and if there's nothing else I can do for you, [PII], have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.