AccountId: 011433970860
ContactId: d49df221-fff1-4d94-8c03-d0efb61f9766
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575390 ms
Total Talk Time (AGENT): 165091 ms
Total Talk Time (CUSTOMER): 183733 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/d49df221-fff1-4d94-8c03-d0efb61f9766_20250624T19:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] and I'm calling from Medical Clinic of North Texas regarding claim status.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. And first, I'll need a good callback number.
[CUSTOMER][NEUTRAL] Yeah, before providing that information, I would like to disclose our calls are recorded for quality and training purposes. Is that OK for you?
[AGENT][POSITIVE] Yes, that's fine. Thank you.
[CUSTOMER][NEUTRAL] Yeah, a callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] No, thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, one moment please.
[CUSTOMER][NEUTRAL] And the policy number of the member is D as in Delta 41203513.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, do you have the member's social?
[CUSTOMER][NEUTRAL] No, I do not have any social security number of this number.
[AGENT][NEUTRAL] OK, I can look up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] Yeah, could you please uh check with the policy number 02.
[CUSTOMER][NEUTRAL] 585-552
[AGENT][NEUTRAL] And please verify the name and date of birth.
[CUSTOMER][NEUTRAL] Yeah this member's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh this member's uh date of birth is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Yes, I found her in the system. That's her policy number. Um, what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII], and the total charge amount on the claim is $426.04.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and please repeat the bill charges.
[CUSTOMER][NEUTRAL] Yes, the total bill amount on the claim is $426.04.
[AGENT][NEUTRAL] OK. Yes, I'm showing that we received this claim on.
[AGENT][NEUTRAL] See, we received the claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] And the claim paid out for $150 even, and I have the check number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The check number is 2035133.
[CUSTOMER][NEUTRAL] OK, and help me the claim number.
[AGENT][NEUTRAL] The claim number is 3579318.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] Uh, is the check issued for a single amount or bulk amount?
[AGENT][NEUTRAL] A single amount of $150.
[CUSTOMER][NEUTRAL] OK, and may I know the date when the check was issued?
[AGENT][NEUTRAL] Yes, the check was issued on [PII].
[AGENT][NEUTRAL] Well, I'm sorry, it was issued on March.
[CUSTOMER][NEUTRAL] OK, and could you please help me to clear day.
[AGENT][NEUTRAL] I'm sorry, it was issued on [PII] and it cleared on [PII].
[CUSTOMER][NEUTRAL] OK and also could you please help me with the pay to address please.
[AGENT][NEUTRAL] Yes, it was sent to the Medical Clinic of [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you for that information uh.
[CUSTOMER][NEUTRAL] Yeah, for the documentation purpose, uh, could you please, uh, help me with, uh, each line itemwise payment details please.
[AGENT][NEUTRAL] Which lines in particular, I'm showing that only 2 lines paid out.
[CUSTOMER][NEUTRAL] Yeah, could you please help me with the payment details for the line item [PII] and 36415.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes. 99213 paid out for $75.
[AGENT][NEUTRAL] 99396 paid out for $75.
[AGENT][NEUTRAL] And 36415 denied because the benefit maximum was reached.
[CUSTOMER][NEUTRAL] OK, and, uh, could you please help me with uh a load amount on the line item 99396 and 99213?
[AGENT][NEUTRAL] The lot amount, the lat amount is the $75 which is the benefit maximum for those services.
[AGENT][NEUTRAL] Under the policy.
[CUSTOMER][NEUTRAL] OK, for both the line items 99396 and 99213, the allowed amount and the paid amount is $75 even.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and thank you for that information and uh what about the remaining amount after the $75 is it goes towards contractual adjustment or the patient responsibility?
[AGENT][NEUTRAL] Patient responsibility.
[CUSTOMER][NEUTRAL] Yeah, could you please help me the patient responsibility on the line item 99396 and 99213 please.
[AGENT][NEUTRAL] I'm not showing any because the benefit maximum was paid out on those line items. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, we need uh the information regarding the remaining amount after the $75.
[CUSTOMER][NEUTRAL] Is it goes towards uh providers adjustment or is it the best responsibility?
[AGENT][NEUTRAL] Providers adjustment.
[AGENT][NEUTRAL] Because I'm not showing that the patient owes anything else after those payments were made.
[CUSTOMER][NEUTRAL] OK, after the $75 the remaining amount is a contractual adjustment and uh there is no patient responsibility on this claim, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, thank you for that information and uh we didn't issue any EOBR uh correspondence for this uh claim, so will you be able to fax over the information to a fax number please?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] Yeah, our fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. And could you please mention with attention to my name, [PII]
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, that's it for today and uh help me the call reference number for our conversation.
[AGENT][NEUTRAL] You can use my name and today's date for the reference number. My name is [PII]. It's spelled [PII] Last initial is [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you [PII] and thanks for this information. Have a great day and take care. Bye bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye.