AccountId: 011433970860
ContactId: 7aa96850-7322-434e-8642-f01f876738de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 412190 ms
Total Talk Time (AGENT): 109536 ms
Total Talk Time (CUSTOMER): 94586 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/2025/02/05/7aa96850-7322-434e-8642-f01f876738de_20250205T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provide office and uh looking for the reason of the deny.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's a [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, it's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] Uh, it's 80048.
[AGENT][NEUTRAL] OK, that's not a good policy number. Do you have another number?
[CUSTOMER][NEUTRAL] Uh yes, give me one second, please.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] And take your time.
[CUSTOMER][NEUTRAL] Mm yeah, policy number 02464968.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick, sir.
[AGENT][NEUTRAL] OK, thank you. And then what is the data service?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Data services [PII], 2024.
[AGENT][NEUTRAL] Thank you and then what is the charge amount?
[CUSTOMER][NEUTRAL] Uh, charge amount of $213 even 213.
[AGENT][NEUTRAL] Thank you, sir. And then what were the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, it's a 90.
[CUSTOMER][NEUTRAL] Uh, one moment, 97.03 cents.
[AGENT][NEUTRAL] Thank you, sir. And then what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] Uh, medical specialist of Palm Beach.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick, quick hold while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. So I did find the claim number 3550081.
[AGENT][NEUTRAL] Claim was paid $17.03 with check number 2022264 and.
[AGENT][NEUTRAL] It was also denied for office visits are not covered under the patient's policy contract.
[CUSTOMER][NEUTRAL] Office visits, sir, are not covered. Why office visits are not covered? Which, what services are covered under the patient policy?
[AGENT][NEUTRAL] The office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, so what was the services covered under the patient policy?
[AGENT][NEUTRAL] The service that was covered that was paid was procedure 93,000.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and uh how many units allow?
[CUSTOMER][NEUTRAL] Uh, for the patient plan?
[AGENT][NEUTRAL] It's not based on units.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so do you have the information about the what services covered under the patient plan?
[AGENT][NEUTRAL] Deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Pinco Insurance, OK. And patient is liable for charges?
[AGENT][NEUTRAL] We don't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, no issue, provide your reference number.
[AGENT][NEUTRAL] Yes, sir. You can use my name. It's [PII], and today's date.
[CUSTOMER][NEUTRAL] To and today's date.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thanks for the informing. Have a nice day.
[AGENT][POSITIVE] You too, you take care [PII]. Thanks for calling APL.