AccountId: 011433970860
ContactId: c5a0cc7d-ed75-4777-87de-e722ff978dd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320220 ms
Total Talk Time (AGENT): 171802 ms
Total Talk Time (CUSTOMER): 84262 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/c5a0cc7d-ed75-4777-87de-e722ff978dd7_20250618T19:04_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] I'm calling from office, checking on the claims.
[AGENT][NEUTRAL] [PII], I can help with the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, my, sorry, could you come again?
[AGENT][NEUTRAL] Yes, I can help with the claim status. What is the policy number, please, so that I can look up the claim.
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number of the patient is 10.
[CUSTOMER][NEUTRAL] 66
[CUSTOMER][NEUTRAL] 922.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, the date of service?
[AGENT][NEUTRAL] Is there a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[CUSTOMER][NEUTRAL] 301
[CUSTOMER][NEUTRAL] [PII]. It's a dark line, no extension.
[AGENT][NEUTRAL] Thank you. What is the date of service that we're looking for for uh [PII]?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Thank you. Is there a bill amount that I should look for?
[CUSTOMER][NEUTRAL] Bill amount is
[CUSTOMER][NEUTRAL] $3,196.
[AGENT][POSITIVE] OK, thank you very much. It looks like uh your claim number on this.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Is 3592932. It looks like we received your claim.
[AGENT][NEUTRAL] Uh let me just check here.
[AGENT][NEUTRAL] Um, uh.
[AGENT][NEUTRAL] On the [PII], we processed it on the [PII].
[AGENT][POSITIVE] Now, these policies have a benefit.
[AGENT][NEUTRAL] Uh, $500 per occasion, but that benefit had already been paid out.
[AGENT][NEUTRAL] With, um, another claim by the time we received your benefits.
[AGENT][NEUTRAL] So, uh, [PII], the, the.
[CUSTOMER][NEUTRAL] So the claim
[CUSTOMER][NEUTRAL] The claim got denied, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's, that's correct because the patient's, um, policy, the benefit had already been maxed out.
[CUSTOMER][NEUTRAL] Uh, with them.
[CUSTOMER][NEUTRAL] Oh, the benefits which we were built, it is the anesthesia services. Does the anesthesia services covered on the patient plan?
[AGENT][NEUTRAL] Of any type of what service again?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Outpatient hospital services are covered. It's just that they're covered at $500 per occasion, which is just a verification benefits, not a guarantee of payment, but that benefit had already been paid before we received your claim.
[AGENT][NEUTRAL] So the claim was denied.
[CUSTOMER][NEUTRAL] Uh, so, so the claim got denied as non-covered.
[AGENT][NEUTRAL] Well, it got denied because the benefit had already been paid out, the benefit had met. So it was covered, it's covered, but the benefit had already been paid out.
[AGENT][NEUTRAL] To someone else.
[CUSTOMER][NEUTRAL] Oh, the coverage was paid to someone else. Am I right?
[AGENT][NEUTRAL] So the benefit is.
[AGENT][NEUTRAL] Uh the benefit had already been paid to somebody else, to another, to another provider. So there is a benefit for this. It is covered. It's just that that benefit had already been paid out to another, another provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there any other data service that we need to look?
[CUSTOMER][NEUTRAL] OK. May I know to whom it is paid?
[AGENT][NEUTRAL] No, no, I can't tell you who it was paid to. I'm sorry.
[CUSTOMER][NEUTRAL] Because we have built the two CPTs with the same uh like on the same date of service with different different providers.
[AGENT][NEUTRAL] What is the bill amount for the for the um for the other uh charge?
[CUSTOMER][NEUTRAL] For also the same, same bill amount.
[AGENT][NEUTRAL] OK. So $3,196. OK. So that claim number is 35.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 92
[AGENT][NEGATIVE] 927 that was also denied um because the uh the bill the um payment had already gone to another provider. We received that claim also on the [PII] and processed it on the [PII], but again the benefit had been paid out already and so it wasn't, it wasn't available to pay out again.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fine. Could you help me with the uh your name spelling?
[AGENT][NEUTRAL] My name is [PII], that's [PII] We'll use that in today's date, which is the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else that I can help with?
[CUSTOMER][NEUTRAL] Uh, nothing else.
[AGENT][NEUTRAL] OK, thank you for contacting API.