AccountId: 011433970860
ContactId: 92b558c3-535e-4405-a60a-f6ad61dc54d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320269 ms
Total Talk Time (AGENT): 106004 ms
Total Talk Time (CUSTOMER): 77321 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/92b558c3-535e-4405-a60a-f6ad61dc54d3_20250410T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office. I'm looking for a claim status.
[AGENT][NEUTRAL] OK, I could check on a client for you. Uh, [PII], can I get a good call back number for you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be D as in Delta 437.
[CUSTOMER][NEUTRAL] 32467.
[AGENT][NEUTRAL] OK, so [PII], that's not one of our policy numbers. That is through, uh, they're called 90 Degree benefits. I can give you their information and transfer you to them if you'd like or if you have their social, I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] There.
[CUSTOMER][NEUTRAL] OK, I have uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And what was the name for the member?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then did you have that date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] Yeah, this one for $172 even.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what was the name of this provider's office phone?
[CUSTOMER][NEUTRAL] Summit Ray Services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that. Just a moment. Alright, so it looks like we did receive that claim, uh, we were unable to pay a benefit as the calendar year maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] All calendar year maximum on diagnosis services exhausted right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know when it got exhausted exactly like the exact date?
[AGENT][NEGATIVE] I'm unable to give that information as that was through a different provider.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So we can build the patient, right?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, and I do have one more claim on the same patient.
[AGENT][NEUTRAL] OK, was that the same date of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was that bill amount?
[CUSTOMER][NEUTRAL] $318 even.
[AGENT][NEUTRAL] 3:18. OK, one moment.
[AGENT][NEUTRAL] Was that for 2 procedure codes, Rome?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, was that 721-28 and 70,450?
[CUSTOMER][NEUTRAL] Yeah, that's the one.
[AGENT][NEUTRAL] OK, alright, yes, I've found this one, the denial reason is the same as that diagnostic benefit had been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK, alright, yeah.
[CUSTOMER][NEUTRAL] OK, can I also get the claim received and denied it?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] That claim was received [PII].
[AGENT][NEUTRAL] And that was processed [PII].
[CUSTOMER][NEUTRAL] And what was your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And call reference number.
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date and so my last initial is A. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, anyway, thank you so much for your time and for assisting me. I hope you have a good day.
[AGENT][POSITIVE] Of course, thank you for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.