AccountId: 011433970860
ContactId: cc153e7f-110d-4de2-93b1-857c984b25d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301679 ms
Total Talk Time (AGENT): 143640 ms
Total Talk Time (CUSTOMER): 117983 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/cc153e7f-110d-4de2-93b1-857c984b25d4_20250220T14:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Contacting APO, my name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes hi good morning my name.
[CUSTOMER][NEUTRAL] It's [PII]. I'm calling to inquire about a claim.
[AGENT][NEUTRAL] I can help with claim status.
[CUSTOMER][NEUTRAL] That we send
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure, I can help with the claim status. What is that policy number, please?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, let me give you the claim.
[CUSTOMER][NEUTRAL] You said the ID number?
[AGENT][NEUTRAL] Yes, yeah, the policy number, please.
[CUSTOMER][NEUTRAL] OK. Yes, 1404110M.
[CUSTOMER][NEUTRAL] The letter L and the number 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number that I can have in the event we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII]. I sent the claim by paper. I had spoken to a rep back on [PII].
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] And what is the data service?
[CUSTOMER][NEUTRAL] The date um I'm sorry, you're going in and out. The date of service is 3-22-23.
[AGENT][NEUTRAL] 32223. OK, thank you. I'll just, and is there a particular bill amount that I need to look at?
[CUSTOMER][NEUTRAL] 23, yes.
[CUSTOMER][NEUTRAL] Uh, yes, give me one moment.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] $4,875.
[AGENT][NEUTRAL] OK, thank you. So this is a facility bill, I guess.
[CUSTOMER][NEUTRAL] Think. Well, it's too.
[CUSTOMER][NEUTRAL] Yes, it's 2 providers. So the main provider is gonna be Doctor [PII], and then the assistant, it's uh [PII].
[AGENT][NEUTRAL] I see. OK, thank you. I'm just looking at that now.
[AGENT][NEUTRAL] OK, it looks like your claim number.
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] 054. So again, that's 3522.
[AGENT][NEUTRAL] 054. Now we received your claim for this on the uh [PII] and we processed it on [PII], 2024. So we received it on the [PII]. We processed it on [PII]. The uh the um policy holder has for outpatient services such as this.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, they have outpatient benefits up to $750 per calendar year. Um, that is just the verification benefits, not a guarantee of payment, but they had met their, uh, policy maximum back in August, uh, several months before we received your claim. So that $750 had gone to other providers. It had already been used.
[AGENT][NEUTRAL] By the time we received your claim, so this uh claim was denied as having no further benefits for the calendar year [PII].
[AGENT][POSITIVE] Yeah, I can send you
[CUSTOMER][NEUTRAL] OK, give me one moment so.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, OK, so, uh, she had benefits of $750 as for outpatient. However, those $750 already went to other providers by the time you guys received the claim, correct?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEGATIVE] OK, so the, this, uh, the secondary will not pay for this services.
[AGENT][NEUTRAL] No, all, no, all of her benefits had already been used by the time that, that we received your claim. So, um, and there's a calendar year. It, it renews every calendar year, but for the calendar year that uh [PII], all of her benefits that had already been used.
[CUSTOMER][NEUTRAL] Are you OK.
[CUSTOMER][NEUTRAL] And it's outpatient. OK, put calendar here.
[CUSTOMER][POSITIVE] OK, thank you so much. Um, can I have your name and a reference number?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can you fax me that or email it to me if it's possible?
[AGENT][NEUTRAL] I can fax it to you. What is your fax number, please?
[CUSTOMER][NEUTRAL] OK. It's [PII] and you could put attention, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So it's 9546 billing and collections. OK, billing collections. And that's [PII].
[CUSTOMER][NEUTRAL] A billing and collection.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] 24.
[AGENT][POSITIVE] OK, yes, I can certainly do that.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, thank you for contacting ATL have a good morning.