AccountId: 011433970860
ContactId: 11febd7d-0311-46ef-bd90-3e8b5fcca210
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243360 ms
Total Talk Time (AGENT): 84630 ms
Total Talk Time (CUSTOMER): 123169 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/11febd7d-0311-46ef-bd90-3e8b5fcca210_20250124T20:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hello, I'm [PII] calling from provider's office regarding our claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02509520 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. It's [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, [PII], and you are needing eligibility or claim status?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] Alright, I can help you with that. What is the date of service, please?
[CUSTOMER][NEUTRAL] Day of services [PII] with a bill amount of $542 even.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the facility name is
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[AGENT][NEUTRAL] Alright, thank you [PII]. I can help you with that claim status. We received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was denied as per the policy guidelines for the patient, office visits are not covered.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, stating that office.
[CUSTOMER][NEUTRAL] Visits are not covered under the member's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the, why the office is, uh, could you please help me with the, whether the provider is out of network?
[AGENT][NEUTRAL] There's no network on this policy. We're secondary to the major medical.
[CUSTOMER][NEUTRAL] OK, I just wanted to make sure is this copay amount is.
[CUSTOMER][NEUTRAL] Not covered, right?
[AGENT][POSITIVE] That is correct. It is a non-covered service.
[CUSTOMER][NEUTRAL] OK. May I know the uh what does the member plan has?
[AGENT][NEUTRAL] It is a secondary gap policy.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yes. Could you please, like, I just wanted to make sure, uh, like the, the, the patient does not have the copay amount to be covered, am I right? Go sir, co-pay. Mhm.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No benefits for the office visit.
[CUSTOMER][NEUTRAL] $40.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Could you please help me with the claim number?
[AGENT][NEUTRAL] The claim number is 34, I'm sorry, 354.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 1203.
[CUSTOMER][NEUTRAL] Could you please help me out all the friends?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Can you spell your name with the last name [PII], please.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. That's the information. Thank you for assisting me. Have a wonderful day ahead sir.
[AGENT][POSITIVE] It's my pleasure to assist you and thank you for calling APL. You take care.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] That