AccountId: 011433970860
ContactId: fbf27278-c80a-4821-8266-37c347ac9c86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 629609 ms
Total Talk Time (AGENT): 173813 ms
Total Talk Time (CUSTOMER): 224793 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/fbf27278-c80a-4821-8266-37c347ac9c86_20250404T17:12_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in customer service. How are you today?
[AGENT][POSITIVE] I'm good, [PII]. How are you?
[CUSTOMER][NEUTRAL] I'm fine, thank you, ma'am. Miss [PII], I have a provider on the phone. His name is [PII].
[CUSTOMER][NEUTRAL] I didn't verify his number, but let me give you the number he's calling from. I do apologize.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No worries go ahead.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, he is calling on participant policy.
[CUSTOMER][NEUTRAL] Policy number 2510491.
[AGENT][NEUTRAL] All right, [PII].
[CUSTOMER][NEUTRAL] Participant number one. Now we can say that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, for Mr. [PII].
[CUSTOMER][NEUTRAL] Right, and I verified the date of birth and I guess the address sounded close anyway, um, I, yeah, I couldn't fully understand it. OK, the date of service is called on claims date of service, if I understand correctly, is [PII].
[AGENT][POSITIVE] OK, perfect. And then do we get a build amount or?
[CUSTOMER][NEGATIVE] No, I didn't. I did not. I did not.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No worries. No worries. If you wanna go ahead and send him over, [PII], I can take the call.
[CUSTOMER][POSITIVE] All right. Thank you, dear. Have a good day.
[AGENT][POSITIVE] You too. Take care, [PII].
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] This is [PII]. Hi, this is [PII] over in customer care. Is this [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, hi, [PII]. Yeah, you're speaking with [PII].
[AGENT][NEUTRAL] Yes, [PII], so I understand that you need to check on a claim status, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, you're right for that.
[AGENT][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] Alright and then may I please have the bill amount?
[CUSTOMER][NEUTRAL] Um, total charges for this patient gonna pay, um, $725 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] So we did receive a claim for the state of service, claim was received [PII]. There was a benefit payment sent in the amount of $50 in a single check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was processed [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Um, I do want to know one thing, like if the claim is, uh, uh, the total charges is $725 right? So you paid only $50. And uh we do, uh, under, yeah, underpaid for $566.25 right? So I just want to know that like is the balance is patient responsibility?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the facility or provider.
[CUSTOMER][NEUTRAL] Medical
[CUSTOMER][NEUTRAL] OK. And uh would you please help me with the claim number?
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 1415.
[CUSTOMER][NEUTRAL] OK. Uh, so, um, when we have checking the EOB, so the bill charges is reflecting as $50 only, not the $745.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, um, can you please send the copy of COB states like like the total bill charges for 725?
[AGENT][NEUTRAL] Yes, what's the fax number?
[CUSTOMER][NEUTRAL] Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm, that was [PII]?
[CUSTOMER][NEUTRAL] Yes. And also on the same day, I do have another claim with the $470 even. Um, so would you please uh help me with that info?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The other bill amount was for $470 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, so claim was received for this date of service and build them out on [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim was denied. The maximum benefit for the state of service had already been paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, the first, sorry, I didn't get you.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Um, um, I didn't get the denial reason. So can you please help me with the denial reason again?
[AGENT][POSITIVE] Benefit maximum for the state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh would you please help me, uh, can you please also fax this copy of your bill?
[AGENT][POSITIVE] Mhm. Absolutely. Anything else I can help with?
[CUSTOMER][NEUTRAL] Uh, I do have one other claim for the same, um, patient for the different data service. Would you please also fax you for that also?
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge is gonna be $1,585.27.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the fax number again is [PII]?
[CUSTOMER][POSITIVE] Yes, you're right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] like 2.
[AGENT][NEUTRAL] Right, so this claim was received on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim is processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And the EOB is on its way for this one as well.
[CUSTOMER][NEUTRAL] as well
[CUSTOMER][NEUTRAL] And also on the same date, I do have uh for for $70 even.
[CUSTOMER][NEUTRAL] These are the
[CUSTOMER][NEUTRAL] I might
[AGENT][NEUTRAL] OK, that claim was also received. It was denied as the max benefit payment had already been made for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, um, max, uh, so you said that like, uh, for the patient, uh, information, you cannot, um, I should, right?
[AGENT][NEUTRAL] I'm sorry, what was your question again?
[CUSTOMER][NEUTRAL] Um, so, uh, if it is
[CUSTOMER][NEUTRAL] If, uh, if the patient plan got already made, so we can the balance with the patient, right?
[AGENT][NEUTRAL] We can advise on what you're able to build that's up to the facility or provider.
[CUSTOMER][NEUTRAL] OK, OK, got it. Um, also, can you please, uh, fax this one also?
[AGENT][POSITIVE] Yes, already on its way. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, just give, um, sir, I do want to be call reference number that's it.
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], which is [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] And yeah, thank you, sir. Thank you for helping, but I know for the questions for the day. Have a nice day and a happy weekend to you.
[AGENT][NEUTRAL] You too. Bye-bye.