AccountId: 011433970860
ContactId: a773d5ea-06b4-46bd-b2ca-0e475cd92895
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346589 ms
Total Talk Time (AGENT): 131280 ms
Total Talk Time (CUSTOMER): 125641 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/a773d5ea-06b4-46bd-b2ca-0e475cd92895_20250117T20:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from the billing office of West Baha Medical Center to check for the status of the claim for quality and training purposes. This call may be recorded and monitored.
[AGENT][POSITIVE] Right, Ness, I'm happy to check on a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] 1372335 M for Mary, L for Lima, and number 7.
[AGENT][POSITIVE] All right, thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] Date of service, [PII] with a total charge of $17,510 even.
[AGENT][NEUTRAL] Do you have an amount that uh after the primary by chance?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you have a build out after the primary?
[CUSTOMER][NEUTRAL] Uh, the deductible is 4,365.75.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because we're the secondary insurance, so I was just wondering if maybe there was a different amount.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So we did receive a claim data service for [PII] with a billed amount for $4,365.75.
[AGENT][NEUTRAL] Uh, it looks like a benefit payment was sent in the amount of $2,403.61.
[AGENT][NEUTRAL] Uh, this payment looks like it maxed out the plan for the year, so nothing additional was payable.
[CUSTOMER][NEUTRAL] And do you have the information when did you receive the claim?
[AGENT][NEUTRAL] Uh, yes, the claim was received. Do you need the received date?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Claim was received [PII].
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][NEUTRAL] Do you have the one?
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] So it was recently uh processed only. So uh did they send out the EOB already for this and payment as also payment is.
[CUSTOMER][NEUTRAL] Is this a patient responsibility or what? Or there's no patient responsibility?
[AGENT][NEUTRAL] We're not able to advise on the patient responsibility that would be up to the provider facility.
[CUSTOMER][NEUTRAL] So the payment for this claim is only $2,403.61.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and as you said the maximum allowed.
[CUSTOMER][NEUTRAL] Amount on the plan. I'm sorry, what's that again?
[AGENT][NEUTRAL] Uh, that was the only amount payable because it looks like.
[AGENT][NEUTRAL] Uh, with this payment, um, the max benefit for the policy has been met for the year.
[CUSTOMER][NEUTRAL] What you benefit.
[CUSTOMER][NEUTRAL] For the year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So exhausted already the maximum benefits allowed for this uh member.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, do you have the claim number?
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 1774.
[CUSTOMER][NEUTRAL] OK. And do you have a call reference? And by the way, uh, do you have the, I'm sorry, I'm, I'm sorry, [PII], do you have the check details?
[AGENT][NEUTRAL] Co
[AGENT][NEUTRAL] Mhm. Absolutely. Let me give it to you. So it's a single check.
[AGENT][NEUTRAL] And the check number, let me get that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 202.
[AGENT][NEUTRAL] 3046.
[CUSTOMER][NEUTRAL] And it should be.
[AGENT][NEUTRAL] Was the [PII].
[AGENT][NEUTRAL] Of January.
[CUSTOMER][NEUTRAL] [PII], sir. OK.
[CUSTOMER][POSITIVE] All right. And do you have the call reference. Thank you very much.
[AGENT][NEUTRAL] Mhm. Call reference is going to be my name with my last initial in today's date. My name again is [PII], that's [PII]
[AGENT][NEUTRAL] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] The last.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII]. You've been very helpful and have a good day. Enjoy your weekend. Bye.
[AGENT][NEUTRAL] You too bye bye.