AccountId: 011433970860
ContactId: 85411875-1a76-4923-8306-df2eabd038ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379059 ms
Total Talk Time (AGENT): 128580 ms
Total Talk Time (CUSTOMER): 192349 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/85411875-1a76-4923-8306-df2eabd038ed_20250129T15:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yeah, hi, this is [PII] calling for doctor office and to check on my claim status, could you please help me find that one?
[AGENT][POSITIVE] I'm happy to check on a claim for you today, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It was 02512593.
[AGENT][POSITIVE] Alright, thank you for that one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service?
[CUSTOMER][NEUTRAL] Sure, the data service is [PII] and the bill amount is $735 even.
[AGENT][POSITIVE] All right, thank you so much. Let me take a look.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Today
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh no, no, no, 19324.
[AGENT][NEUTRAL] Thank you for your patience on that. So it looks like we did receive this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was uh a benefit payment was sent in the amount of $50.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, what, it's $50 right? OK, OK.
[AGENT][POSITIVE] For $50 correct.
[CUSTOMER][NEUTRAL] I'm on the payment they can let him in the way.
[AGENT][NEUTRAL] And it was a single check. The claim was processed [PII].
[CUSTOMER][NEUTRAL] Oh no, you want to like, uh, please resubmit and make sure that.
[AGENT][NEUTRAL] Do you need the check number?
[CUSTOMER][NEUTRAL] Uh, um, yes, uh, can the check number?
[AGENT][NEUTRAL] Check number is 2015861.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's a single, it's a single jet, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And may I know the issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And uh could you please check that this time there are 3 CPD lines, right? Can I have the allowed amount and paid amount for each one CPD codes?
[AGENT][NEUTRAL] OK, so for CPT code.
[CUSTOMER][NEUTRAL] Is there any detail on this claim, OK.
[AGENT][NEUTRAL] Yeah, so this was maximum benefit payment allowed um with this check, the maximum benefit payable for this day a service had been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So maximum benefits is already met, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know the
[CUSTOMER][NEUTRAL] Uh-huh, me date when it was uh that was gone the payment.
[AGENT][NEUTRAL] It was met with this payment, so that would have been [PII].
[CUSTOMER][NEUTRAL] So it was met with the payment, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A little bit
[CUSTOMER][NEUTRAL] OK, and, uh, OK, thank you so much. So, so that's, is there any possible to report the claim, uh, we need to submit any appeal on this claim because, uh.
[CUSTOMER][NEUTRAL] Uh, there is only the total amount is counted it was $735 but insurance only paid $15.50 dollars, right?
[AGENT][POSITIVE] Correct, because that was the max benefit payable.
[CUSTOMER][NEUTRAL] So, uh, is it?
[CUSTOMER][NEUTRAL] So it's a max number of there, right, OK, and may I know the claim number?
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 492 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much. So, and may know the mailing address?
[AGENT][NEUTRAL] Appeals must be filed within 180 days of the decision. The appeal mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, thank you. And the time limit is 180 days from the prostate, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, uh, is there any, you know, the payer ID and the fax number.
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much. And can I call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Thank you. Thank you, sir, first talk with you. Have a great day. Bye-bye now.
[AGENT][NEUTRAL] You too [PII] bye bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye