AccountId: 011433970860
ContactId: 8f89592d-8b0e-4a34-a73a-f04c9e350eb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643559 ms
Total Talk Time (AGENT): 133287 ms
Total Talk Time (CUSTOMER): 110454 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/8f89592d-8b0e-4a34-a73a-f04c9e350eb3_20250228T15:03_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL.
[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I need to check on a claim payment please.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can I please get your name, your callback number, and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And I'm calling from dermatology Institute.
[AGENT][NEUTRAL] OK, and then what is your name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], thank you so much. And then can you also give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII], and the policy number is 251-7285.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] I think she has another name in the system. I think it's under [PII] Eligible.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Um, I have her as [PII].
[AGENT][NEUTRAL] I have a Resmic
[CUSTOMER][NEUTRAL] OK, she must have changed.
[AGENT][NEUTRAL] OK, and what is her data service?
[AGENT][NEUTRAL] And charge out.
[CUSTOMER][NEUTRAL] It is [PII] for a total of $238.74.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this up and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, Miss [PII]. So I do have the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the claim number is 351-214-3.
[AGENT][NEUTRAL] The claim was paid with check.
[CUSTOMER][NEUTRAL] I'm sorry, give that to me again.
[AGENT][NEUTRAL] 351-214-3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was paid with check number 2005941 on [PII].
[AGENT][NEUTRAL] In the amount of $75.
[AGENT][NEUTRAL] And the check was cashed on [PII].
[AGENT][NEUTRAL] After that $75 payment and ma the benefits.
[CUSTOMER][NEUTRAL] OK, so that was for the um 99203. Was there, there's not gonna be a payment on the other two lines?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And is that because the service isn't covered?
[AGENT][NEUTRAL] The maximum benefit payable for that date of service was met.
[AGENT][NEUTRAL] And then on
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] On procedure J 3590.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have a report that says.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] The policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] Right, um.
[CUSTOMER][NEUTRAL] So is the second line patients responsibility, the 2676?
[AGENT][NEUTRAL] We don't give patient responsibility because that's determined by the provider.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And how are we supposed to make that decision if we don't have a remit that says to build the patients?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Now I can send you a copy of the EOB.
[CUSTOMER][NEGATIVE] I'm a little confused.
[CUSTOMER][NEUTRAL] Does it say patient responsibility on the EOB?
[AGENT][NEUTRAL] No, we never give patient responsibility because because that's determined by the provider.
[CUSTOMER][NEUTRAL] Doesn't
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can I get a copy of the EOB?
[AGENT][POSITIVE] Absolutely. What's your fax number?
[CUSTOMER][NEUTRAL] It is 410431.
[CUSTOMER][NEUTRAL] 893 5.
[CUSTOMER][NEUTRAL] Attention [PII] in billing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII] OK alright Miss [PII], I'm gonna put you on a brief hold again while I get that fax ready for you and.
[AGENT][NEUTRAL] Right back.
[CUSTOMER][NEUTRAL] OK, thank you. You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Come on
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, perfect, can I just get a call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] Oh, perfect. OK, thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful weekend and we appreciate you calling APL.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye bye, ma'am.