AccountId: 011433970860
ContactId: 95a2a7da-5082-4c3e-b99c-f414dfcd89de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295350 ms
Total Talk Time (AGENT): 92411 ms
Total Talk Time (CUSTOMER): 92411 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/95a2a7da-5082-4c3e-b99c-f414dfcd89de_20250115T21:57_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider office to check on claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, um, [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Oh, yeah, sure.
[CUSTOMER][NEUTRAL] It's gonna be 02277898.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII]. Last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. The total bill amount is 1000, I'm sorry, it's
[CUSTOMER][NEUTRAL] Um, yeah, it's $11,366 even.
[AGENT][NEUTRAL] [PII], the amount of 11,366.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Can you verify the procedures codes for me?
[CUSTOMER][NEUTRAL] Yes, uh, uh, I'm looking for the procedure code 43774.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so so you're looking for 43774. OK, it looks like we processed the claim on [PII] and uh that code was denied. The denial reason is that the maximum benefit payable for the date of service was met. It looks like we have sent $500 which is the maximum benefit payable for the date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, what's that amount?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500, right?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK. Like, uh,
[CUSTOMER][NEUTRAL] Only 500 amount will be paid by insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And remaining balances uh to the patient, or like patient will be able to pay.
[CUSTOMER][NEUTRAL] Is it so?
[AGENT][NEUTRAL] It is up to the, it is up to the provider's discretion, um, but yes, mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, no problem. What's the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEGATIVE] Uh no thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else?
[CUSTOMER][POSITIVE] Like, uh, uh, I do have one more question. I'm so sorry for that. Like, uh, uh, the maximum benefits that's met in terms of a dollar, right?
[AGENT][POSITIVE] Yeah. No problem.
[AGENT][POSITIVE] Dollar Valley, yes. This one has a daily benefit of $500.
[CUSTOMER][NEUTRAL] And the total the total 500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you guys already paid remaining balance is not gonna be paid. Oh yeah, no worry.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for the details.
[AGENT][NEUTRAL] Mm