AccountId: 011433970860
ContactId: 7ea24aaf-71e7-4d57-9e4c-08a14f00adc0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444649 ms
Total Talk Time (AGENT): 102199 ms
Total Talk Time (CUSTOMER): 150245 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/7ea24aaf-71e7-4d57-9e4c-08a14f00adc0_20250226T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help?
[CUSTOMER][NEUTRAL] So I be [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling on behalf of a provider. I want to check the status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get the callback number that you're calling from?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And then what is the name of the facility you're calling from [PII]?
[CUSTOMER][NEUTRAL] That is Ascension Medical Group.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I also get the name of the patient, the date of birth, and the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02507096. The name of the patient is [PII]. The date of birth of the patient is [PII].
[AGENT][NEUTRAL] OK, let me pull up her policy real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Well
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] OK and then what is the data service?
[AGENT][NEUTRAL] And charge amount?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The charge amount is 2977.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it's $29.77 or it's.
[AGENT][NEUTRAL] $2,977.
[CUSTOMER][NEUTRAL] That is $2,977 even.
[AGENT][NEUTRAL] OK, thank you. I'm gonna put you on a brief hold while I look up this claim for you, [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] Yes. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So looking at the claim, I found the claim it is 353-840-3.
[AGENT][NEUTRAL] The claim was paid $100 with check number 2017209.
[AGENT][NEUTRAL] The check cleared the bank on [PII]. After that $100 was paid, it maxed out the benefits.
[CUSTOMER][NEUTRAL] OK, so you're saying that the patient has a maximum benefits limit of $100 which is already paid in the one CPT. 02 CPTs are denied. Is that correct? OK, so, so as per the plan that patient has, it can only be payable up to $100 per claim.
[AGENT][POSITIVE] Correct. That's correct.
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] So what is the plan patient of?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The patient has a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, as I can see, all three CPTs are different. They are not the same CPTs. On one is speed.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] After the $100 was paid.
[CUSTOMER][NEUTRAL] Hm. So like,
[AGENT][NEUTRAL] It maxed out the benefit for that day. The benefit is maxed out. There's no money left.
[CUSTOMER][NEUTRAL] OK, so per day limit for the patient is $100.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so for the other CBDs, are these patient responsibilities or like we can build the CBTs to patient.
[AGENT][NEUTRAL] Uh, I can't give patient responsibility because that's determined by the provider.
[CUSTOMER][NEUTRAL] OK, so as for the plan which patient has, it states that only $100 can be payable, payable per day for the for the patient, which is already paid as I can see in CBT 99243, thus other remains unpaid.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. So like, may I have the call reference number for today?
[AGENT][NEUTRAL] Yes sir, you can use my name it's [PII] and today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] How do you spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, and today's date is [PII]. So thank you, [PII]. That's it for my side for today. Have a nice day. Bye bye. Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] You too.