AccountId: 011433970860
ContactId: be61293f-e9d4-42ba-90cd-108c42a3dbc3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576419 ms
Total Talk Time (AGENT): 100502 ms
Total Talk Time (CUSTOMER): 124822 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/be61293f-e9d4-42ba-90cd-108c42a3dbc3_20250115T16:29_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, [PII], this is [PII] calling from uh Alpha Medical Center regarding checking on status on the plane. And how do you spell your name, [PII]?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] First initial and last name [PII].
[AGENT][POSITIVE] And I can help you
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I can help you with the claim, [PII], can you please give me your callback number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][POSITIVE] Thank you. And what is the patient's name, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient name I have here that will be it uh uh.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s?
[AGENT][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Uh-huh. It is 02275146.
[AGENT][NEUTRAL] OK, let me pull that in real quick.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, date of service I'll be it is uh [PII].
[CUSTOMER][NEGATIVE] For 70, sorry, for $210 even.
[AGENT][NEUTRAL] OK. And you said you're calling from Alpha Medical Group, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, we submitted to, uh, we submitted the claim to APL on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, alright, I will check for that. Thank you for that information and I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. I did find the claim. The claim number is 521261.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because the benefits were maxed for the calendar.
[CUSTOMER][NEUTRAL] When was the claim received? It was received on uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm. And it was uh.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] And denied on the same day? Uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So what was the denied reason?
[AGENT][NEUTRAL] Benefits were maxed for the calendar year.
[CUSTOMER][NEUTRAL] So what is the max allowable on this?
[CUSTOMER][NEUTRAL] What is the max allowable benefit for this patient?
[AGENT][NEUTRAL] It depends on what it is, um, but the, the ben the benefits were exhausted for the year.
[CUSTOMER][NEUTRAL] Yeah, that's what is it for, um, uh, what was the total uh amount or the visits?
[AGENT][NEUTRAL] I can't give you that because you're not the only provider that they used.
[CUSTOMER][NEUTRAL] You go.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Disclose the.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Max allowable benefit info.
[CUSTOMER][NEUTRAL] Since we are not only the provider use right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Provider yes OK do you know the last date of services that was used?
[AGENT][NEUTRAL] No, I can't give that out. That's private information.
[CUSTOMER][NEUTRAL] OK, will you be able to fax me the OB copy please?
[AGENT][POSITIVE] Yes sir, I can do that for you. What is your fax number?
[CUSTOMER][NEUTRAL] Uh huh, that will be it is uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 7498.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I send that fax to you. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me I got that fax on the way to you.
[CUSTOMER][NEUTRAL] Uh, OK. What's the call reference number?
[AGENT][NEUTRAL] You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] Thank you you have a good day and thank you for calling AP sales.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.