AccountId: 011433970860
ContactId: 7b5e9ba0-c499-4127-9450-82919af39349
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258920 ms
Total Talk Time (AGENT): 123499 ms
Total Talk Time (CUSTOMER): 113353 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/7b5e9ba0-c499-4127-9450-82919af39349_20250214T16:04_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. My name is [PII]. I'm calling from provider's office. I'm checking on claim status.
[AGENT][NEUTRAL] Like, I can help with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] Uh, yeah, just a second.
[CUSTOMER][NEUTRAL] Yeah, the policy number, uh, that is 02474924.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and this is for a medical claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, and if I can have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh, the callback number is [PII]. Extension is [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] [PII]. OK. And is there a particular building out that I should look at?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, $289 even.
[AGENT][POSITIVE] OK, thank you very much. I'm just looking at that now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number on this.
[AGENT][NEUTRAL] Is 353 7.
[AGENT][NEUTRAL] 706.
[AGENT][NEUTRAL] And it looks like.
[CUSTOMER][NEUTRAL] Yeah. Actually, um,
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah, I, I am aware about this status. The claim is denied. We have the UB. Uh, the denial states the policy provides no benefits for the charges made by a doctor for an inpatient visit. Uh, so, uh, we just want to know if this is a patient responsibility because this, uh, plan, uh, service is not current patient's plan. So can we bill this claim to patient?
[AGENT][NEUTRAL] Well, I can't really tell you that. Um, the only thing I can tell you is that his policy doesn't cover it. Um, now, it's a limited benefit policy and, and so, um, the only thing I can tell you, I, I can't really tell you to go bill the patient. What I can tell you is that our obligation was met with this, uh, you know, there was a payment made, um, on this uh for a different service on the same day and our, and our obligation was met on that. So any, any other charges like that.
[AGENT][NEUTRAL] You would probably need to contact the, the insured, but I, I can't tell you that, that they're, that they owe it. cause it's very possible that they have another um policy uh because this is such a limited benefit policy. It's, it's very possible that they have something else. So, um, you may want to contact them, but.
[CUSTOMER][NEUTRAL] Do you, do you have info uh do you have any information like who is the primary care for this patient?
[AGENT][NEUTRAL] Uh, no, sir. I do not. Uh, I've only, I only know what we've got and, and that's it.
[CUSTOMER][NEUTRAL] Uh, do you have this inform that you are the primary? Are you, do you have that confirmation?
[AGENT][NEUTRAL] Uh, no, I do not. Um, I, I don't have, I don't know anything. I just, I can tell you what we've got and then that's it. I can tell you that what we have is very, very limited in, in the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right, so inpatient services are not covered in the patient's plan, right?
[AGENT][NEUTRAL] Uh, those, those type of visits are not, no.
[CUSTOMER][NEUTRAL] OK, fine. Uh just a second. Uh, yeah, and how do you spell your name?
[AGENT][NEUTRAL] It's [PII] and the first letter of my last name is [PII] Yes, it's [PII] and the first initial of my last name is [PII]
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, [PII], uh, OK, I, um, this patient, uh, also have one more insurance. I'm not sure if it is an insurance or not. Uh, this, it is a 90-degree benefits, multi-plan employer group uh group plan. So is it something, uh, related to your insurance or something else? Do you have any information about that?
[AGENT][NEUTRAL] No, I'm, I'm very sorry, [PII]. The only thing I've got is just, it's just the, the policy that we have. I realized that he gets it through his employer, but.
[CUSTOMER][NEUTRAL] All right,
[CUSTOMER][POSITIVE] Uh, all right, no issues. Uh, we'll connect, uh, we'll connect with the patient to inquire about it. Thank you so much. Uh, what is the uh call reference number?
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][POSITIVE] All right, all right, [PII], thank you so much for the information. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh huh, if there's nothing else to help with, thanks for contacting you.