AccountId: 011433970860
ContactId: a411a22e-c0b0-4f55-8dc1-6c55218ddab8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386200 ms
Total Talk Time (AGENT): 95559 ms
Total Talk Time (CUSTOMER): 124623 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/a411a22e-c0b0-4f55-8dc1-6c55218ddab8_20250417T22:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] from provider's office to check on a claim status.
[AGENT][POSITIVE] I'm happy to check on a claim for you. Uh, what's the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy ID would be 02576516.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I'm sure the patient's name would be [PII].
[CUSTOMER][NEUTRAL] And the date of birth is on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright, thank you so much and you need to check on a claim, correct?
[CUSTOMER][NEUTRAL] I need to check on a claim.
[AGENT][NEUTRAL] Alright, what's the date of service?
[CUSTOMER][NEUTRAL] Yes the services on [PII] um of total bill amount.
[CUSTOMER][NEUTRAL] $651 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, thank you so much for your patience on that. So it looks like we did receive a claim for this state of service on [PII].
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] It was received on [PII] and processed on [PII].
[CUSTOMER][POSITIVE] Yes, thank you and also the status of the claim.
[AGENT][NEUTRAL] Claim was denied, maximum benefit for the state of service has been met.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Maximum benefits exceed. Uh, may I know, uh, the maximum benefits was existed in the term of, uh, uh, visit or the, the
[CUSTOMER][NEUTRAL] Dollars.
[AGENT][NEUTRAL] Let me check here one moment. Let's see.
[AGENT][NEUTRAL] It looks like it was a max benefit as far as dollars.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much. And what's the maximum dollar amount has uh has been spent to the patient?
[AGENT][NEUTRAL] The benefit amount for an ER visit on the patient plan is a benefit payment of $150.
[AGENT][NEUTRAL] That's already been exhausted?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] And patient has succeeded the maximum uh dollar rate that is $150.
[AGENT][NEUTRAL] For the state of service, yes.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, could you please fax me a copy of an EOB?
[AGENT][NEUTRAL] Mhm. What's the fax number?
[CUSTOMER][NEUTRAL] Is the fax number would be [PII]. Um, just to confirm it is [PII].
[AGENT][NEUTRAL] All right. Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] It's to the attention of my name, [PII]. It could be spelled as uh [PII]
[AGENT][NEUTRAL] All right. So I'm sending that now. Give it about 5 minutes to come through.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can I have the claim number.
[AGENT][NEUTRAL] Claim number is gonna be 355.
[AGENT][NEUTRAL] 8480.
[CUSTOMER][NEUTRAL] 4805. Thank you. And uh can I have the call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Call reference is my name with my last initial, then today's date. My name again is [PII], that's [PII]
[AGENT][NEUTRAL] And my last initial is [PII].
[CUSTOMER][POSITIVE] Yes, thank you so much, [PII]. And uh thank you. I've got the required information I needed and thank you so much for assisting me. Before that, uh, don't forget to fax the copy of the UB so for the, the future reference, uh and for documentation purpose, we need a copy of a UV.
[AGENT][POSITIVE] Absolutely, it's on its way, [PII].
[CUSTOMER][POSITIVE] Yes, thank you, and it's a pleasure uh talking to you. Thank you so much for assisting me. Have a great day. Bye for now.
[AGENT][NEUTRAL] You too bye bye.