AccountId: 011433970860
ContactId: a1f06bca-860c-4e90-a197-b29e81a99a86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545590 ms
Total Talk Time (AGENT): 135632 ms
Total Talk Time (CUSTOMER): 139385 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/a1f06bca-860c-4e90-a197-b29e81a99a86_20250411T15:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], last initial [PII] for [PII]. I need to discuss a claim.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. No extension.
[AGENT][NEUTRAL] OK, thank you. And you're calling from which facility for annotation?
[CUSTOMER][NEUTRAL] This is for orthopedic anesthesia pain specialist.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02036914 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, you have a date of service and the amount.
[CUSTOMER][NEUTRAL] [PII] $3060 even.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The claim number 3571011.
[AGENT][NEUTRAL] OK, let me pull this image. One moment.
[AGENT][NEUTRAL] It's gonna be a minute. I'm waiting on the AOB to pull up.
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] I see you're waiting on the system.
[AGENT][NEUTRAL] OK, so we process this claim and deny stating that the maximum benefit payable for the date of service has been met.
[CUSTOMER][NEUTRAL] What you mean maximum benefit, how much the benefit for the same date of service and how much paid?
[AGENT][NEUTRAL] This policy is a secondary policy to the major medical. It has a daily benefit amount of $500 for any claims we receive for that date of service.
[CUSTOMER][NEUTRAL] OK. So for the same date of service, [PII], so over, over, uh over $500 or under $500 was already paid for this patient?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] How much paid
[AGENT][NEUTRAL] $500 is the maximum benefit. By the time we receive your claim, she already exhausted her benefit.
[CUSTOMER][NEUTRAL] OK. So, uh, I mean the same date of service you received the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For which charge amount?
[CUSTOMER][NEUTRAL] And what's the claim number?
[AGENT][NEUTRAL] We cannot release that information. It's not your provider service. It's not your claim. We cannot release that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. Let me provide you the NPI number and just for verification, OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I have the I have the NPI number which you already, I mean, paid the claim initially for the same date of service. This is 1861667982 under this NPI.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Doctor
[CUSTOMER][NEUTRAL] Uh doctor named [PII].
[AGENT][NEUTRAL] I mean
[AGENT][NEUTRAL] One moment, because we don't really work with MPIs like that. Bear with me.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So it's simply that APL daily limit to pay for data services, uh, not up to $500 right?
[AGENT][NEUTRAL] The daily benefit for this member, for this policy, all of our policies are different. This one is $500 per day.
[CUSTOMER][POSITIVE] All day. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you provide me the complete plain name of the patient?
[AGENT][NEUTRAL] The what? I'm sorry?
[CUSTOMER][NEUTRAL] The plain name.
[AGENT][NEUTRAL] The plan name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this is a secondary supplemental plan for the major medical.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and again, I cannot release the information about the payment on the that date of service. I can only give you information about your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK. You only provide me our claim um information just to verify.
[CUSTOMER][NEUTRAL] Under Doctor [PII], you already paid $500.
[CUSTOMER][NEUTRAL] For same member?
[AGENT][NEUTRAL] What's the name again of the doctor?
[CUSTOMER][NEUTRAL] Doctor [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] Do you know the total charge amount?
[AGENT][NEUTRAL] For his claim
[CUSTOMER][NEUTRAL] No, no, I don't have any charge amount. I have only any yeah.
[AGENT][NEGATIVE] Then I cannot release information.
[AGENT][NEUTRAL] Mm. I cannot release information like that. I can only give you information about your claim. So if you're calling from orthopedic anesthesia, I can give you the information for orthopedic anesthesia. I cannot release information from another provider.
[CUSTOMER][NEUTRAL] What's your name, please?
[AGENT][NEUTRAL] My name is [PII]. My name is [PII].
[CUSTOMER][POSITIVE] Thank you. What's your name?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. What's the reference number?
[AGENT][NEUTRAL] We don't have a reference number so you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII].
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You