AccountId: 011433970860
ContactId: bb9c28e4-0521-427f-908f-015f507eefdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572419 ms
Total Talk Time (AGENT): 203405 ms
Total Talk Time (CUSTOMER): 183337 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/bb9c28e4-0521-427f-908f-015f507eefdf_20250327T13:55_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. I'm calling from provider's office to check the claim status.
[AGENT][NEUTRAL] I can help with the claim status. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. Um, and what is your policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 0255.
[CUSTOMER][NEUTRAL] 596 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are you looking for for [PII]?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII], and the charge amount is $1,198.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Checking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Your claim number for this.
[AGENT][NEUTRAL] Is 357.
[AGENT][NEUTRAL] 2551.
[AGENT][NEUTRAL] Now, it looks like we received your claim.
[AGENT][NEUTRAL] Uh, let me just check here.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK. Looks like we received the claim on the [PII] and we processed it on the [PII]. Now, the, the
[AGENT][NEUTRAL] Policy has just a certain amount of of benefits for outpatient services.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it looks like uh the amount of the benefits um for outpatient services is $1000 and that was already, that had already been paid out for this occasion by the time that we received your claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So the full benefit of $1000 had already been paid, all the benefits have been exhausted by the time that we received your claim.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So your claim number is 357.
[AGENT][NEUTRAL] 2551, but it was denied because all of the benefits had been maxed out.
[CUSTOMER][POSITIVE] All benefits.
[AGENT][NEUTRAL] Uh-huh, had been knocked out.
[CUSTOMER][NEUTRAL] has been maxed out. So,
[CUSTOMER][NEUTRAL] So according to you, mm, the primary insurance has already paid the allowed amount.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Yes, actually I do have some more data of service for the same patient. Could you please help me with that?
[AGENT][NEUTRAL] OK, and what is the, what is the next date of service?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next date of services.
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $412 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEGATIVE] I don't have anything for $430.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's $412 412.
[AGENT][NEUTRAL] $412. Ah, thank you so much. OK. So for that, the claim number is um 357.
[AGENT][NEUTRAL] Just a moment please. 357.
[AGENT][NEUTRAL] 2703.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK so um.
[AGENT][NEUTRAL] It looks like, uh, let me just check here.
[AGENT][NEUTRAL] It looks like we received your claim.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Oh how much is uh.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] I'm sorry, there's just so many of these, um.
[AGENT][NEUTRAL] We received your claim on the [PII]. Yes, uh-huh.
[CUSTOMER][POSITIVE] OK. It's all right.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] We received your claim on the [PII], we processed it on the [PII], but again, all the benefits for this data service, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In December have been have been met, so that it, it was denied because all the benefits have been paid out.
[CUSTOMER][NEUTRAL] Mm, OK, what is the allowed amount on this?
[AGENT][NEUTRAL] $1000 per calendar year and of course that's just a verification, not a guarantee of payment, but that's how much was paid out and it it had already been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks so much.
[CUSTOMER][NEUTRAL] Ready for next date of service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can do one more. What is that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[CUSTOMER][NEUTRAL] With the charge amount?
[CUSTOMER][NEUTRAL] $1,198.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9
[AGENT][NEUTRAL] I'm still just checking.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] OK, I'm not sure that I have a claim for that amount, um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm still checking.
[CUSTOMER][NEUTRAL] It's a 10 it's 1198.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And date of service [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, I just don't see it. I mean, there's, there's other charges, but I just don't.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I'm not seeing that particular amount build amount.
[CUSTOMER][NEUTRAL] I do have the claim number. May I provide that?
[AGENT][NEUTRAL] Do you, yes, because there's so many of these claims. What is the claim number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The claim number is 3,572,250.
[AGENT][NEUTRAL] 2250. OK, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like that might.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] yeah.
[AGENT][NEUTRAL] All right, it looks like this is the same thing where we received your claim, uh, after all the benefits have been paid out. Um, here we go.
[AGENT][NEUTRAL] Yeah, there it is. OK. So it looks like we received that before, uh, by the time all the benefits have been paid out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks like we received that claim, um.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] the same provider.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, it looks like we received that claim, um.
[AGENT][NEUTRAL] Back in [PII], it was processed on [PII], but again, all those benefits had been paid out.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so much for this information, [PII]. Could you please spell your name for documentation and call the number?
[AGENT][NEUTRAL] Yes, it's [PII] and we're gonna use that today's date as our reference.
[CUSTOMER][POSITIVE] OK, OK, thank you, thanks so much.
[AGENT][POSITIVE] OK, thank you for contacting AT have a good.