AccountId: 011433970860
ContactId: e60e5ffa-9918-44c3-b7d8-e0d8d8dff85c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241279 ms
Total Talk Time (AGENT): 87987 ms
Total Talk Time (CUSTOMER): 70640 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/e60e5ffa-9918-44c3-b7d8-e0d8d8dff85c_20250618T13:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling about a claim that an EOB that we received and
[CUSTOMER][NEUTRAL] So there was no payment on two of the CPT codes from calling for claim status.
[AGENT][NEUTRAL] All right, [PII], let's check on the claim. What is the policy number? Do we have that?
[CUSTOMER][NEUTRAL] Yes, it's D for Danny, 43732965.
[AGENT][NEGATIVE] Unfortunately I can't pull him with that number. Do you have the claim number by any chance?
[CUSTOMER][NEUTRAL] Oh, the, um, OK, let me see.
[CUSTOMER][NEUTRAL] Yes, claim number it is 358-83993.
[AGENT][NEUTRAL] OK, let me pull this.
[AGENT][NEUTRAL] If I can just get the insured's uh name and date of birth, please.
[CUSTOMER][NEUTRAL] Yes, um, her name is [PII], [PII].
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so on this claim, I do see that there was a benefit payment sent and the other two are looking like denied because showing it was the maximum benefit for the date of service. So the $75 was the max benefit for the visit.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, so the other two other two codes, the J code and the 96372. So there are, so the uh those balance goes towards the patient?
[AGENT][NEUTRAL] Yeah, I mean, it's up to the facility or provider as far as patient responsibility, but the patient's plan is a limited benefit plan so it only pays a set amount depending upon what they're being seen or treated for. It looks like their plan pays the $75 and that's it, nothing additional.
[CUSTOMER][NEUTRAL] OK, so the, the patient has a limited plan and it only pays $75 towards the balance of $345.
[AGENT][NEGATIVE] Towards the office visit, yes, that's all it's gonna pay. It's not gonna pay anything additional.
[CUSTOMER][NEUTRAL] OK, so the J denied from, you say it was denied for maximum benefit.
[CUSTOMER][POSITIVE] Then I for maximum benefit.
[AGENT][POSITIVE] Maximum benefits paid for the date of service, yes.
[CUSTOMER][NEUTRAL] Pay for data service.
[CUSTOMER][NEUTRAL] OK, day of service.
[CUSTOMER][NEUTRAL] And it's up to us if we just if we
[CUSTOMER][NEUTRAL] Note it down to the patient.
[AGENT][NEUTRAL] Yeah, we don't advise on patient responsibility.
[CUSTOMER][NEUTRAL] OK, can I have a call reference number?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with today's date. My name again is [PII], which is [PII] Initial to my last name is gonna be [PII] and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you ma'am you have a good day.
[AGENT][NEUTRAL] You too [PII] bye bye.