AccountId: 011433970860
ContactId: dc656789-53a1-495f-906e-22a15d51d8b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399519 ms
Total Talk Time (AGENT): 87555 ms
Total Talk Time (CUSTOMER): 219372 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/dc656789-53a1-495f-906e-22a15d51d8b5_20250408T12:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. Good morning. This is [PII]. I'm calling from provider office and I'm looking at claim status for one member. Can you please assist me with that?
[AGENT][NEUTRAL] I can help you, [PII], and you can also check your status online at [PII]. Do you have the policy number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, the policy number of the member is 02563355.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is.
[CUSTOMER][NEUTRAL] [PII] sorry, it's [PII].
[AGENT][NEUTRAL] OK, thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member named [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Alright thank you and if you could verify uh the date of service and the charge and this is for claim status correct?
[CUSTOMER][NEUTRAL] That's right. OK. And uh date of service is uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bill amount $484 even.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] In that time actually I'm not looking for a general status. I have some question regarding this claim, so once you pull up, please let me know so that uh I will provide you my concern in this one.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Yes, uh, the claim number I have that is 354-5633.
[AGENT][NEUTRAL] OK, so I'm showing that under a different policy number.
[CUSTOMER][NEUTRAL] 563-3 uh that's in a different OK.
[CUSTOMER][NEUTRAL] The policy number on that is 02563351.
[AGENT][NEUTRAL] OK, that's what I show and what was your question?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes. Actually, ma'am, we billed a total of uh
[CUSTOMER][NEUTRAL] 5 CPT codes to your side.
[CUSTOMER][NEGATIVE] And we just get a payment for only one procedure code. The rest of the codes were denied.
[CUSTOMER][NEUTRAL] And uh if I'm looking for a denial reason then it shows like uh.
[CUSTOMER][NEUTRAL] Maximum units were already paid for that equipment. So, can you just provide me the information like how many units are allowed for these procedure codes in how much period of time?
[AGENT][NEUTRAL] OK, do you have a copy of the of the APL explanation of benefits?
[CUSTOMER][NEUTRAL] Uh yes, I have that in front of me.
[AGENT][NEUTRAL] Mhm, can you turn to the back and read the remark description on the back?
[CUSTOMER][NEUTRAL] Uh, yes, bear with me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, it shows like the calendar year maximum of the wellness benefit has been met.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, ma'am, uh, that's what I want to know. Like, I just need to know how many units or how many times we can build these items in a year. Can you just provide me that information?
[AGENT][POSITIVE] OK, so you wanna know the maximum benefit for wellness.
[CUSTOMER][NEUTRAL] Yes, you can see that.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so the calendar year maximum is $250.
[CUSTOMER][NEUTRAL] $250. OK. So,
[CUSTOMER][NEUTRAL] Ma'am, can you just provide me the dates when it was paid, like,
[AGENT][NEUTRAL] OK, it's from a different provider's claim.
[CUSTOMER][NEUTRAL] On it was built.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] So the maximum was met.
[CUSTOMER][NEUTRAL] OK, so can you just.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Mhm. Sorry, go ahead.
[CUSTOMER][NEUTRAL] [PII]. OK. So.
[CUSTOMER][NEUTRAL] May do you have any date when it was uh maxed out?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And ma'am, uh, can you just provide me one more information like, uh, you said the total allowed amount for the wellness is only $250 which has already been met. And as for you, there is some other provider who build that equipment. So, uh, can you just provide me that information like, uh, how much?
[CUSTOMER][NEUTRAL] Uh, it was paid to that provider. Can you just provide me the amount?
[AGENT][NEUTRAL] No, we cannot, just your claim.
[AGENT][NEUTRAL] We can only provide you information regarding your claim, not another provider's claim.
[CUSTOMER][NEUTRAL] So do you guys process and.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, not an issue. So can you just check how many uh
[CUSTOMER][NEUTRAL] Times we build
[CUSTOMER][NEUTRAL] Wellness benefits to your side in [PII]?
[AGENT][NEUTRAL] How many times your office filled a wellness claim?
[CUSTOMER][NEUTRAL] Like how much is the total payment made to?
[CUSTOMER][NEUTRAL] Uh yes, or you can say like how much.
[AGENT][NEUTRAL] Just once.
[AGENT][NEUTRAL] Yeah, so your office build one wellness claim and so we can't answer any questions regarding any other providers claims, only yours.
[CUSTOMER][NEUTRAL] Only this one
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][NEUTRAL] No, ma'am, I got my point now. What do you want to say and uh that's OK. Mhm. So can you just provide me a reference number for our conversation, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll be my name in today's date, [PII]. And any other questions, [PII], I can help out with today?
[CUSTOMER][POSITIVE] Uh, no, thank you so much, dear. You already helped me a lot. So have a nice day. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] Mhm