AccountId: 011433970860
ContactId: 2504e28a-355b-47fc-9f49-dc61959ef09b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635049 ms
Total Talk Time (AGENT): 196107 ms
Total Talk Time (CUSTOMER): 175018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/2504e28a-355b-47fc-9f49-dc61959ef09b_20250131T20:26_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, I have 4 of them.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it would be, it would be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yes. The, it would be 1665215.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is [PII]. Last name is [PII]. [PII], let me spell it out. It's [PII] And the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, the data service is on [PII] bill amount of $542.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Gastro Health LLC.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The claim, go ahead.
[CUSTOMER][NEUTRAL] Uh, it's, oh yes, please go on.
[CUSTOMER][NEUTRAL] Oh, I didn't understand what you said, ma'am.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 7904.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because this is not a covered loss under the plan, therefore, no amount is payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I didn't understand, ma'am. Could you repeat that?
[AGENT][NEUTRAL] Sure, it's not a covered charge, so the benefits are not payable.
[CUSTOMER][NEUTRAL] Under the patient's plans, is that right, ma'am?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And may I know like uh uh the office visits are not covered or something else?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Yes, code 99204 is not covered under the policy.
[CUSTOMER][NEUTRAL] OK, I understand, ma'am.
[CUSTOMER][NEUTRAL] It's in the.
[CUSTOMER][POSITIVE] Yes, thank you for that information and yes, shall I go ahead and provide you with the next member's ID?
[AGENT][NEUTRAL] Uh, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Oh yes, ma'am. The next member's policy is
[CUSTOMER][NEUTRAL] 2, no, it's 02066715, Mike Lima number 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. The patient's first name is [PII]. Last name is [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And um again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, it's on [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Yes, the bill amount is $348 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And would this be the same provider or a different provider?
[CUSTOMER][NEUTRAL] Uh, it would be for the same provider.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3352164.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] My [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you for the information, ma'am. Let me provide you with the next member's ID.
[AGENT][NEUTRAL] Um, hold on one moment, let me note this policy.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, it would be 020129308.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 020129308.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That looks like too many numbers. Let me try again.
[AGENT][NEUTRAL] Yeah, there's no policy with that number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 0201290 uh could you like please verify using the member's name for this one?
[AGENT][NEUTRAL] Sure. Do you have the member's social?
[CUSTOMER][NEUTRAL] Um, give me one moment, ma'am. Let me verify that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, ma'am, we don't have the social security number with me.
[AGENT][NEUTRAL] OK, um, and what is the member's first and last name? Can you spell it for me, please?
[CUSTOMER][NEUTRAL] Yes, the first name would be
[CUSTOMER][NEUTRAL] [PII], it's [PII] Last name is [PII], [PII]
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And this is for her medical policy?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify her date of birth?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. Um, so the policy number is 2,012,930.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it's on [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It would be for $2610 even.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I'm showing that the claim, oh wait a minute, 223.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And that claim number is 333.
[AGENT][NEUTRAL] 9223.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As the um maximum benefit payable for the data service has been met.
[CUSTOMER][NEUTRAL] And benefits have been exhausted.
[AGENT][NEUTRAL] Yes, for this data service.
[CUSTOMER][NEUTRAL] That would be it, ma'am. Could you provide me the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII].
[CUSTOMER][POSITIVE] Yes, thank you for that, [PII], and I hope you have a great day ahead. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII]. You, you also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Right.