AccountId: 011433970860
ContactId: feafc00e-7e4b-49a3-b280-0bc5db829a56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385859 ms
Total Talk Time (AGENT): 97573 ms
Total Talk Time (CUSTOMER): 125319 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/feafc00e-7e4b-49a3-b280-0bc5db829a56_20250604T13:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider office to check on the claim status.
[AGENT][NEUTRAL] OK. Happy to check on the claim, right. Can I get the policy number?
[CUSTOMER][NEUTRAL] Of course, the policy number would be 02609441.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] with the extension of [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] The name would be [PII], and the date of birth would be [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, the date of service would be [PII], and the total bill amount is $456.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Thank you for your patience. So we did receive this claim on [PII]. Claim was processed on [PII]. There was a benefit payment sent in the amount of $50. This was the maximum for the date of service.
[CUSTOMER][NEUTRAL] Once again, uh, what's the status of the claim right now?
[AGENT][NEUTRAL] Claim has been processed and paid.
[CUSTOMER][NEUTRAL] It's still in process and being paid, right?
[AGENT][NEUTRAL] It's been
[CUSTOMER][NEUTRAL] So we can consider it as in, still it is in process, we can consider that.
[AGENT][NEUTRAL] No, it's been processed.
[CUSTOMER][NEUTRAL] It's processed.
[CUSTOMER][NEUTRAL] OK. So it isn't paid. OK. What's the, could you please tell me what's the paid amount?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] $50. Is there any some sense or it is only $50?
[AGENT][NEUTRAL] Only $50 even.
[CUSTOMER][NEUTRAL] OK. And what's the allowed amount?
[AGENT][NEUTRAL] That was the maximum benefit for that date of service, so $50.
[CUSTOMER][NEUTRAL] OK. 1 2nd.
[CUSTOMER][NEUTRAL] OK. May I know when this maximum uh may I know the date when the maximum benefit amount reached?
[CUSTOMER][NEUTRAL] Hello my name is [PII].
[AGENT][NEUTRAL] So it was the maximum benefit for that particular date of service meaning that for an office visit it looks like, I believe it was only gonna pay that amount.
[AGENT][NEUTRAL] So, based off of the patient's plan,
[AGENT][NEUTRAL] It was only gonna pay that amount towards the visit. That's the benefit amount which is $50.
[CUSTOMER][NEUTRAL] OK. uh, what's the claim number?
[AGENT][NEUTRAL] 3605799
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And may I know the, your call reference number?
[AGENT][NEUTRAL] That would be my name with today's date. My name is [PII], that's [PII], last initial [PII], and today's date.
[CUSTOMER][NEUTRAL] Once again the
[CUSTOMER][NEUTRAL] Well then, could you please hold for a second? Let me check the more details.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] Mhm. Yeah. What did you need to check?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. Uh.
[CUSTOMER][NEUTRAL] Uh, uh, from the mic, I got that you have said that the claim has been, uh, denied for maximum benefit or pay for maximum benefit, right?
[CUSTOMER][NEUTRAL] And process on [PII] and process on [PII], right?
[AGENT][NEUTRAL] Right, the maximum benefits been paid, correct?
[CUSTOMER][NEUTRAL] OK, and the pay amount was $50 right? And there is no copatient responsible.
[AGENT][NEUTRAL] The paid amount was $50 correct.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] OK. And you can tell me why, how much was the maximum benefit for this [PII] or it was paid in before that, any date of service.
[AGENT][NEUTRAL] So the maximum benefit for an office visit is $50 on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, for the, as for the plan you have paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you.