AccountId: 011433970860
ContactId: b0c36fea-83ba-4922-8c78-8b25f8f7ede4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1313540 ms
Total Talk Time (AGENT): 298614 ms
Total Talk Time (CUSTOMER): 285396 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/b0c36fea-83ba-4922-8c78-8b25f8f7ede4_20250506T19:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I?
[CUSTOMER][NEUTRAL] Hi, this is [PII] here calling from products office. I'm looking for a claim status before that, uh, your voice is not. Could you please set your mic?
[AGENT][POSITIVE] OK, thank you sir hold on real quick.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK thank you can you please spell your first name for me sir?
[CUSTOMER][NEUTRAL] Uh yeah. Still, uh here and there, your voice is in a note. My name will be [PII], and the initial will be [PII].
[AGENT][POSITIVE] OK, thank you [PII]. I appreciate you verifying your name for me and I can help you with claim status. Can you please give me your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, before that, if you don't mind, could you please spell out your name for me for the recommendation purpose?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] How about initial?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK. The patient name will be
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is the policy number, sir?
[CUSTOMER][NEUTRAL] 1,153,970.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then what is the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $7,209.60.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] 1500, they apply towards deductible.
[AGENT][NEUTRAL] OK, and then [PII], can you please give me the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Uh yes, sure.
[CUSTOMER][NEUTRAL] I'm calling from Cleveland Clinic, Florida.
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a quick hold, Mr. [PII], while I look at this claim for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh shoot.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII] I have the claim ready for you.
[AGENT][NEUTRAL] The claim number is 3503981.
[AGENT][NEUTRAL] And the claim has been denied because the benefit has been maxed for the calendar year.
[AGENT][NEUTRAL] You there?
[CUSTOMER][NEUTRAL] Yeah, yes, I'm here. Uh, sorry, I was on mute. Yeah, that's what my question is like, uh, I do see the claim has been denied for the maximum benefit exhausted. I wanted to know whether it is based on the units, basis on the dollar amount or how?
[AGENT][NEUTRAL] So the um per day occurrence has to be separated by 90 days and this was not separated by 90 days therefore the benefit was maxed.
[CUSTOMER][NEGATIVE] You mean to say like these services should be billed only once in the 90 days, right?
[AGENT][NEUTRAL] Right, for this benefit.
[CUSTOMER][NEUTRAL] OK. Uh,
[AGENT][NEUTRAL] For the treatment of the.
[AGENT][NEUTRAL] or related condition.
[CUSTOMER][NEUTRAL] OK. Could you please uh help me with the call reference number for this patient. After that, I do have 4 more patients for the day.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, you can use my name [PII]
[AGENT][NEUTRAL] And today's date for all of the claims.
[CUSTOMER][NEUTRAL] OK, [PII], uh, just a second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, can I go ahead with the new member ID?
[AGENT][NEUTRAL] Yes, what is the member's ID number?
[CUSTOMER][NEUTRAL] 02483143 M as [PII].
[AGENT][NEUTRAL] OK, and what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth will be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look up that policy.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] [PII] for the charge amount.
[CUSTOMER][NEUTRAL] $293.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] Uh, even the primary insurance didn't pay, they, uh, applied towards patient responsibility as copay for $93.76.
[AGENT][NEUTRAL] OK. And is it also for Cleveland Clinic?
[CUSTOMER][NEUTRAL] Yeah, just a second. Let me confirm that cross-check by cross-checking. Yeah, same, Cleveland Clinic, Florida.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold again. I'm gonna look this one up for us and I'll be right back.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me [PII]. So looking on data service of [PII] for the amount that you have given me, I do not find a claim on file.
[CUSTOMER][NEUTRAL] Oh, you mean to say for the $293 there is no, for the bill amount 29, there is no claim on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, could you please, uh, help me with the member's ID, I mean, the effective date?
[AGENT][POSITIVE] Yes let me give that to you.
[AGENT][NEUTRAL] The effective date of the policy is [PII] and then the policy terminated on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, could you please help me with the electronic payer ID?
[AGENT][NEUTRAL] Yes, that is 60801.
[CUSTOMER][NEUTRAL] [PII]. Uh, what will be the correct mailing address, claims mailing address?
[AGENT][NEUTRAL] That is [PII]. That's in [PII], Ok.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And what is, what will be the timely filing limit?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK. Uh, I
[CUSTOMER][NEUTRAL] Shall I go ahead with the next patient?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, it's 910002566619.
[AGENT][NEUTRAL] OK, that is not one of our policy numbers. Do you see a different number?
[CUSTOMER][NEUTRAL] Uh sorry, uh, my mistake. Uh, the policy number will be 82275186.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Hello, are you there?
[CUSTOMER][NEUTRAL] Hello? Can you hear me?
[AGENT][NEUTRAL] Yes, I hear you [PII]. I'm sorry there must have been a just a break in the call for a moment.
[AGENT][NEGATIVE] So looking at that policy number, it is also not a good policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second then.
[CUSTOMER][NEUTRAL] Uh, let me crosscheck why, uh.
[CUSTOMER][NEUTRAL] Could you please try to check with this?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00565.
[CUSTOMER][NEUTRAL] 35937134
[AGENT][NEUTRAL] No sir, that's not gonna be one of ours either it's too many digits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] Mm, just bear with me one second. I think there's some glitch in.
[AGENT][NEUTRAL] Do you have the social?
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yeah. Can I go ahead with the member ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, what
[AGENT][NEUTRAL] OK, that looks more like it. Let me look on that one.
[AGENT][NEUTRAL] OK, it is searching.
[AGENT][NEUTRAL] Go be just one moment. It's trying to find it.
[CUSTOMER][NEUTRAL] Actually, uh, initially, we have discussed about this patient, but now I got one more claim for that patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] For [PII], yes. So it's going to be another claim for for Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] It's going to be $7,209.60. 720,960.
[AGENT][NEUTRAL] OK, and then what is the charge after the primary?
[CUSTOMER][NEUTRAL] Uh, $1500.
[AGENT][NEUTRAL] OK, and then can you please, is it also for Cleveland Clinic?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright I'm gonna put you on a quick hold again I'm gonna look this one up and I'll be right back sir.
[CUSTOMER][NEUTRAL] Sure, sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you very much for holding for me. I do have the claim. The claim number is 3,510,180. claim was paid $500 after the payment of $500 it maxed out the benefit.
[AGENT][NEUTRAL] The check number is 2004532.
[AGENT][POSITIVE] That check did clear the bank.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] Let me get 200453.
[CUSTOMER][NEUTRAL] Uh, sorry, I have a specific question. I, hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, my question regarding this claim is this claim is denied for maximum benefit exhausted. So I wanted to know uh the limit whether it is based on the
[CUSTOMER][NEUTRAL] Visits or units or how much or how?
[AGENT][MIXED] OK, but the claim was paid.
[CUSTOMER][NEGATIVE] Yeah, it is paid and partially denied as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the $500 is the benefit amount per per day so it maxed out the benefit amount of $500.
[CUSTOMER][NEUTRAL] Uh, I didn't get one. Could you please repeat this?
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Yes, and this is just to verify benefits. It's not a guarantee of payment. So on this patient's policy they get $500.
[AGENT][NEUTRAL] That $500 was paid and after that it maxed out the benefit.
[CUSTOMER][NEUTRAL] So you mean to say uh for this patient on this claim, particular claim, only, only
[CUSTOMER][NEUTRAL] $500 is allowable, like payable amount.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] More than that, it's maximum benefit, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, uh, for even for this, the claim call reference number will be your name and the date of today's date, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, [PII], uh, that's it. As of now, it was nice having you on call. Bye-bye. Take care. Thank you so much.
[AGENT][POSITIVE] You have a wonderful day [PII] and thank you for calling APL you take care also bye bye sir.
[CUSTOMER][NEUTRAL] Yeah, bye bye.