AccountId: 011433970860
ContactId: f14faea6-fb97-4393-b2ab-57349368aed2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386140 ms
Total Talk Time (AGENT): 70943 ms
Total Talk Time (CUSTOMER): 129789 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/f14faea6-fb97-4393-b2ab-57349368aed2_20250127T17:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is Will calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] with.
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII] with the extension [PII].
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name?
[CUSTOMER][NEUTRAL] And then what is the patient
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Uh, should I spell that for you?
[AGENT][NEUTRAL] No sir, I've got it. What's the last date of birth?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] Uh, the date of birth is [PII]. And I'm sorry, I couldn't catch your name at first. Could you please repeat that for me?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And what's the last name you said your name sorry?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and what's the last, uh, policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02506255.
[AGENT][NEUTRAL] OK, let me pull that in for us real quick.
[CUSTOMER][NEUTRAL] Yeah, sure, and, and if you want, I have the claim number as well. I just wanted a clarification on a particular denial on a claim.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, what is the client number?
[CUSTOMER][NEUTRAL] OK, what is the
[CUSTOMER][NEUTRAL] Yeah, so the claim number is 353-0665.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] And what is the name you're calling for?
[CUSTOMER][NEUTRAL] Uh, the facility, right?
[CUSTOMER][NEUTRAL] It's Texas Retina Associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull in that claim, and I'll be right back.
[CUSTOMER][NEUTRAL] I'm gonna put you on a brief hold while I pulled them.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you, Will.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Thank you so much for holding for me. I do find the claim and the claim was paid $46.88.
[CUSTOMER][NEUTRAL] And the claim was paid $4.88.
[CUSTOMER][NEUTRAL] Uh-huh. OK. And there's also one CPT denied on it, that is 992014. And uh I can see here the reason code as office visits are not covered by this policy. And could you please tell me like why is that? Is it according to the patient's plan or provider's contract or something else? It yes, it's, it's, uh, because of the patient's policy.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Yes, it's, it's, uh, because of the patient's policy contract office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Track office business.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, are we eligible to bill this to patients, uh, if this is not covered in the patient's plan and patients have received the services for it?
[AGENT][NEUTRAL] That is uh determined by the provider we don't give patient responsibility.
[CUSTOMER][NEUTRAL] That is uh determined by the providers we don't.
[CUSTOMER][NEUTRAL] OK, that's fine. Uh, can I have the reference number for this call?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][POSITIVE] So that is all for today. Thank you so much for helping me out. Have a great day ahead.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] You too will thank you for calling APL you have a blessed one.
[CUSTOMER][POSITIVE] You too will thank you for calling ATL you have a blessed one. OK bye thank you.
[AGENT][NEUTRAL] Bye-bye, sir.