AccountId: 011433970860
ContactId: 9d7f93db-e9be-4fb3-bf18-6b97ce9cd185
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387700 ms
Total Talk Time (AGENT): 80690 ms
Total Talk Time (CUSTOMER): 131905 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/9d7f93db-e9be-4fb3-bf18-6b97ce9cd185_20250304T17:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII]. I'm calling from Prisma University Medical Group, checking on claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, [PII], OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] That's 230.
[CUSTOMER][NEUTRAL] 9091
[AGENT][NEUTRAL] OK. And then uh what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] [PII] and birthday [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The that I have here.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. OK. And then uh what was that uh billed amount, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] $1,162 even.
[AGENT][NEUTRAL] I'm sorry, that was 1,162.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the basis of most of the game.
[AGENT][NEUTRAL] OK, so we did receive this claim mark. Um, we were unable to pay a benefit as the maximum anesthesia benefit for that date of service had been exhausted.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, I know the dinner there?
[AGENT][NEUTRAL] Yes, one moment, let me get that.
[AGENT][NEUTRAL] So the claim was processed [PII].
[CUSTOMER][NEUTRAL] And it's a claim for maximum benefits for anesthesia has been adjuster, right?
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Yes, they had met their maximum benefit amount.
[CUSTOMER][NEUTRAL] Yeah, and may I know the
[CUSTOMER][NEUTRAL] In dollar, how much would be allowed per day?
[AGENT][NEUTRAL] What was that of the total benefit amount?
[CUSTOMER][NEUTRAL] Yes, I just need a total benefits amount per day.
[AGENT][NEUTRAL] Uh, let me see how much it was for that day. Give me just a moment.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] W
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like that amount was $37.25.
[CUSTOMER][NEUTRAL] Per day it's allowed only 37 and 25.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] No, no, I'm asking you, said the maximum benefits for anesthesia has been adjusted per day, right?
[AGENT][NEUTRAL] For this day, yes, so it's, it pays off of a percentage for the surgical amount as well that pays. So it looks like for this date, it was $37.25.
[CUSTOMER][NEUTRAL] No, actually, I have used here, but they it's allowed only 3725 for a service.
[AGENT][NEUTRAL] No, the anesthesia benefit pays a percentage of the total surgical benefit amount.
[CUSTOMER][NEUTRAL] Yeah, I, I, I just need to know how much uh you have been paid per day for the day. How much you paid for the day.
[AGENT][NEUTRAL] Total, not, you mean, not, do you mean?
[CUSTOMER][NEUTRAL] During the data service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, no. Actually, the 3725 was paid to our provider only. We have received that payment for the different provider under the same group.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] Uh, for the day, that would be not only allowed for $3725 right? There, there will be some more than $100 for anti-ir service, right?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] I just want to know like uh how much patient has met for the day.
[CUSTOMER][NEUTRAL] And uh how much you have been paid for the day, for the all on this service even for the different uh facility uh provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know um they the uh H.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello.