AccountId: 011433970860
ContactId: 97c199f8-d6ac-420b-912d-3eba75312ec4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289269 ms
Total Talk Time (AGENT): 107507 ms
Total Talk Time (CUSTOMER): 93123 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/97c199f8-d6ac-420b-912d-3eba75312ec4_20250113T16:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, So, I'm [PII] calling from Piedmont Athens Hospital, and I have a question on a claim.
[AGENT][POSITIVE] OK, sure, I can assist you with client assisted on. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's 025380887.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK perfect thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. It's [PII] and total charges are $3,434.26.
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, right, and for future you can check claim status online through our website at [PII] and that's just optional and one moment, let me pull this information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You're waiting on the system.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, so it looks like we processed the claim [PII] and we send the $50 which is the maximum for the ER visit.
[AGENT][NEUTRAL] And how may I assist you with this claim?
[CUSTOMER][NEUTRAL] All right, so, uh, this claim was denied stating that the charges for non-covered. I only wanted to confirm that whether these charges are non-covered under patient's plan or under provider's contract.
[AGENT][NEUTRAL] No, this claim was processed and paid. It was paid $50. $50 is the maximum benefit. So with that, uh, check, the maximum payable benefit for this date of service was met.
[CUSTOMER][NEGATIVE] Um, you're right, uh, you guys paid $50 but after that, uh, it was processed again and then it was stating that charges were non-covered.
[CUSTOMER][NEUTRAL] So, uh,
[AGENT][NEUTRAL] I don't, I don't see that claim with us. I only have one claim and it's the one we paid.
[CUSTOMER][NEUTRAL] Uh, yeah, right, so you're saying that $50 was the maximum allowed amount.
[AGENT][NEUTRAL] $50 is the maximum payable amount for this policy. Um, the ER visit is covered at $50 per visit and it's a maximum of 2 visits per covered per person per calendar year and with the payment of the check, the maximum for the date of service was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, got it. Uh, can you please, uh, check with, uh, with the claim number?
[AGENT][NEUTRAL] Uh-huh. Claim number is 353563-9.
[CUSTOMER][NEUTRAL] Uh, uh, please do me a favor. I'll, uh, give you one more claim number. Can you please check with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Uh, it's 2024.
[CUSTOMER][NEUTRAL] 1122
[CUSTOMER][NEUTRAL] 0318.
[AGENT][NEUTRAL] That's not ours, that's IMA.
[AGENT][NEUTRAL] That's another company.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] All right, good. Got it. No worries. Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Mister?
[CUSTOMER][NEUTRAL] Um, yes, please help me out with 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, Mr. [PII]?
[CUSTOMER][POSITIVE] No, nothing else. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You have
[AGENT][NEUTRAL] Mhm