AccountId: 011433970860
ContactId: 062518c0-c378-45c5-9dde-8ec90dc6f4e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395940 ms
Total Talk Time (AGENT): 100972 ms
Total Talk Time (CUSTOMER): 111112 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/062518c0-c378-45c5-9dde-8ec90dc6f4e1_20250411T19:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is I'm calling from provider's office. Could you please help me out with the claim status?
[AGENT][NEUTRAL] Sure. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, OK, and may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Sure, that would be [PII].
[AGENT][NEUTRAL] Uh, can you give me that a little bit slower, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from for my notation?
[CUSTOMER][NEUTRAL] That would be gastrohealth.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it starts with 1337111.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's on the
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $348 even.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim.
[AGENT][NEUTRAL] All right, so it looks like we received the claim on [PII].
[AGENT][NEUTRAL] Process the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office visit under the provider's policy.
[AGENT][NEUTRAL] Under the member's plan, office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Specific claim bill to America.
[AGENT][NEUTRAL] You need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim number is 3464389.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 346-438-9
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, one moment, please allow me for a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, uh, could you please help me out with the name for me?
[AGENT][NEUTRAL] For the what sorry?
[CUSTOMER][NEUTRAL] Your name for me?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, please allow me for a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh yes, sir. So thank you so much for being on hold. And yeah, could you please tell me the, is there any tab for this, uh, office visit?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Any what? I'm sorry for the office visit?
[CUSTOMER][NEUTRAL] I mean, is there any time period for this? Is it for the CPT 99214?
[AGENT][NEUTRAL] No, no, no. Office visit in general is not covered under this patient's plan. So office visits are not covered.
[AGENT][NEUTRAL] It's not because of the code or the type of um office office visits in general are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Office visit is not covered under this policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm, OK, I got the claim number and could you please help me out with the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] OK, that would be
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. I got you. Um.
[CUSTOMER][NEUTRAL] Yeah, that's all about
[CUSTOMER][POSITIVE] Uh, today, I have only one patient. Thank you so much for your information. Thank you so much for your patience. So have a wonderful weekend.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] And you as well. Thank you for calling APL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Goodbye.