AccountId: 011433970860
ContactId: fb7200ee-dda1-4a28-9111-de02075348fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 591330 ms
Total Talk Time (AGENT): 139075 ms
Total Talk Time (CUSTOMER): 109228 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/fb7200ee-dda1-4a28-9111-de02075348fa_20250113T22:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. The last, S [PII], calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's policy number?
[CUSTOMER][NEUTRAL] 02069892.
[AGENT][NEUTRAL] OK, let me look up.
[AGENT][POSITIVE] The insured real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show [PII]. Um, can you please give me the date of service?
[CUSTOMER][NEUTRAL] [PII], the total charge of $1,105 even.
[AGENT][NEUTRAL] And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $121.36.
[AGENT][NEUTRAL] Thank you. And what is the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Saint Peter's bone and joint.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK. Take your time to.
[AGENT][POSITIVE] Thank you, sir. Thank you so much, [PII]. I appreciate it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, [PII]. I've got the claim pulled up. Uh, the claim, the claim number is 353-2274.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I've got 2 remarks on the claim. The first one is that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the second one is all payable benefits were applied to the policy deductible.
[CUSTOMER][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, I can hear you.
[CUSTOMER][NEUTRAL] Yeah, how much is the
[AGENT][NEUTRAL] How much is what, sir?
[CUSTOMER][NEUTRAL] Total amount, amount, amount for the code 7,204,073,030.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It doesn't give me an amount that was paid it just says that it was paid towards the deductible, so.
[AGENT][NEUTRAL] That's not showing
[CUSTOMER][NEUTRAL] How much dollars?
[AGENT][NEGATIVE] I don't have a dollar amount.
[CUSTOMER][NEUTRAL] OK. What about the last code?
[AGENT][NEUTRAL] On code, um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I just have the code is D2M0303.
[CUSTOMER][NEUTRAL] OK. I have the CPD code of [PII] and 72,040 and [PII], right? Do you have that, uh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so [PII] is the CPT code that you have?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that one was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] OK. What about the code [PII]?
[AGENT][NEGATIVE] Those were denied because the benefit went towards the deductible.
[CUSTOMER][NEUTRAL] You have a copy of your be?
[AGENT][NEUTRAL] Yes, I can send you the EOB. Can you please give me your.
[AGENT][NEUTRAL] Fax number.
[CUSTOMER][NEUTRAL] Yeah, it's 888.
[CUSTOMER][NEUTRAL] 369
[CUSTOMER][NEUTRAL] 0040
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, attention to my name is [PII].
[AGENT][NEUTRAL] OK [PII], I'm gonna put you on a brief hold while I send you that fax. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I have sent that fax uh you'll just have to give it a few minutes so it can get to you.
[CUSTOMER][NEUTRAL] OK. Before that, uh,
[CUSTOMER][NEUTRAL] May I know when the claim received and processed?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When can we receive the EOB?
[AGENT][NEUTRAL] I've sent it to you through fax. You just have to give it a couple of minutes to get to you.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] May I know the name and the call reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for assistance. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You too [PII] you have a good night. Thank you for calling APL.
[CUSTOMER][POSITIVE] Good night. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.