AccountId: 011433970860
ContactId: cca0969b-0c35-4396-8ec9-be4f8e62deb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196910 ms
Total Talk Time (AGENT): 84411 ms
Total Talk Time (CUSTOMER): 61559 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/cca0969b-0c35-4396-8ec9-be4f8e62deb1_20250227T17:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office. um, I need help with the patient's claim that denied.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII] and that's a direct line.
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from, from my location?
[CUSTOMER][NEUTRAL] It's Poly Redeemer Family Medicine.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 021-918-997.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and it's $134.43.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, let me see if I have that claim.
[AGENT][NEUTRAL] In the future, you can check claim status online through our website at [PII] and that's just optional. And let me pull the ELB one moment.
[CUSTOMER][NEUTRAL] Yeah, I'm just trying to confirm if the denial is correct that he exceeded his allowed amount of visits and if I should bill him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] In that case, let me put this other.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Um, so, um, yes, that is correct. Um, this policy is a limited policy, which he has, um, office visit benefit up to 6 visits per year, and he already used all 6 benefits or all 6 visits by the time we receive this claim.
[CUSTOMER][NEUTRAL] Oh, OK, he must be going somewhere else for visits because we only have 3 for 2024.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, this is for a PCP or a specialist.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that's all I needed um.
[CUSTOMER][NEUTRAL] Yeah, that's all I need. I just need a reference number.
[AGENT][NEUTRAL] OK, we don't have a reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss?
[CUSTOMER][NEUTRAL] No, did you say 6 visits or 7 visits?
[AGENT][NEUTRAL] 66 per year.
[CUSTOMER][POSITIVE] 6. OK, alright, OK, got it, thank you for your help I appreciate it that's all I needed.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mm. You're welcome and thank you for calling APO. Have a good day, Miss.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Yeah.