AccountId: 011433970860
ContactId: 9db64240-eab2-4568-91fe-188d770bfe34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254500 ms
Total Talk Time (AGENT): 73208 ms
Total Talk Time (CUSTOMER): 88531 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/9db64240-eab2-4568-91fe-188d770bfe34_20250501T13:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider's office and we have questions regarding claim. Could you please help me with it?
[AGENT][NEUTRAL] All right, I'm happy to check the claim, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It's 02341476.
[AGENT][POSITIVE] Thank you. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All right and then date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] The amount $11,950 even.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] I have a specific question regarding this claim.
[AGENT][NEUTRAL] Do you have a claim number, [PII]?
[CUSTOMER][NEUTRAL] Yes, I have PIN number.
[AGENT][NEUTRAL] OK, what's look like?
[CUSTOMER][NEUTRAL] Claim number is
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so I have that here. What were your questions, [PII]?
[CUSTOMER][NEUTRAL] Uh, what is the allowed amount on the claim?
[AGENT][NEUTRAL] Uh, it looks like this payment was the maximum benefit payable for the date of service. The benefit payment was $1000.
[CUSTOMER][NEUTRAL] Uh, it's $1000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is it allowed um is it allowed or paid?
[AGENT][NEUTRAL] That was the paid amount.
[CUSTOMER][NEUTRAL] I'm asking about a loud amount.
[AGENT][NEUTRAL] So that is the max allowed amount as well.
[AGENT][NEUTRAL] So $1000 is the allowed amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, the
[CUSTOMER][NEUTRAL] OK. Actually, the Aetna has left patient responsibility $2,339.38.
[CUSTOMER][NEUTRAL] So, could you please tell me what, what is the remaining amount?
[AGENT][NEGATIVE] Nothing. The patient max for the year for outpatient is $1000 so this claim exhausted their allowed amount for the year.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] In a calendar year, you pay only this much.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Can I have call reference number?
[AGENT][NEUTRAL] [PII] references my name with my last initial and then today's date. My name is [PII], that's [PII] Last initial is [PII] and then today's date.
[CUSTOMER][NEUTRAL] One last thing I wanted to confirm. So, could you please tell me what would be the remaining amount? Would it be patient responsibility or what?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the provider facility.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. That's all for today. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye bye.