AccountId: 011433970860
ContactId: 265a30b2-affd-451f-baa4-7dbc7fa0f2b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 863799 ms
Total Talk Time (AGENT): 250170 ms
Total Talk Time (CUSTOMER): 333350 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/265a30b2-affd-451f-baa4-7dbc7fa0f2b4_20250124T20:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], good, good to hear your name. My name is [PII] calling from provider's office, checking on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Doing pretty well. Thank you for asking, [PII].
[AGENT][NEUTRAL] You're welcome. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] 4 claims.
[CUSTOMER][NEUTRAL] A N
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] it not
[CUSTOMER][NEUTRAL] Which is [PII]. Could you please spell your name? It's [PII] or [PII]?
[AGENT][NEUTRAL] [PII] The [PII] name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] Thank you. Uh-huh. No, thank you for that.
[AGENT][NEUTRAL] Did you need the first initial to my last name?
[CUSTOMER][NEUTRAL] Go ahead. That would be the call reference number, right? OK?
[AGENT][NEUTRAL] Right, L like Larry in today's date?
[CUSTOMER][POSITIVE] Thank you. Mhm.
[AGENT][NEUTRAL] You're welcome. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] 02473158. [PII] Lima 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Under the patient's name, [PII], with the date of birth [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 for the claim and the total bill?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] for $1,362 even.
[AGENT][NEUTRAL] I'm sorry, can you repeat that please slowly?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] For 1 for $1,362 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] I'm calling from Gastro Health.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7886.
[CUSTOMER][NEUTRAL] One moment. Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh go ahead. Thank you.
[AGENT][NEUTRAL] So the claim number is 353.
[AGENT][NEUTRAL] 7886.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the maximum benefit payable for that date of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment. My, my benefits has been exhausted.
[AGENT][POSITIVE] Correct for that data service.
[CUSTOMER][NEUTRAL] OK. What is the dollar amount? What, uh, I mean,
[AGENT][NEUTRAL] So the benefit is up to $300 per calendar day and there were multiple claims that came in and before your claim came in, there was another claim and that amount was paid to that claim.
[CUSTOMER][NEUTRAL] I mean, I'm.
[CUSTOMER][NEUTRAL] OK, 4 days.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] 300 per day.
[CUSTOMER][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] And by the way,
[CUSTOMER][NEUTRAL] I want to ask you.
[CUSTOMER][NEUTRAL] Could you please help me out when was the last service made by this patient on?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's so.
[CUSTOMER][NEUTRAL] [PII]. Thank you. Can I go for the next number ID number, [PII]?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, hold on one moment. Let me note this policy.
[CUSTOMER][NEUTRAL] No, no, finish up. Yes. Finish up your documentation. I will be on silent hold. Thank you.
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 002329703
[AGENT][NEUTRAL] 00232973
[CUSTOMER][NEUTRAL] 002329703
[AGENT][NEUTRAL] 9703.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Uh it's [PII] with date of birth [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 8 12 2024 and built for 237 even.
[AGENT][NEUTRAL] [PII] for $237.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] All right, so I'm showing that this claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] That claim number is 3351-6300.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Moment, sorry. One moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm on your portal itself. I'm just downloading the with the claim number which you have provided. Go ahead. Thank you.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Help me on whatever plan does the patient have like a supplement gap plan or something like that.
[AGENT][NEUTRAL] Yes, this is the supplemental gap insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, supplemental.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Supplemental gap insurance. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Just I downloaded a copy of EO. Thank you for your patience. [PII], almost done.
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][POSITIVE] Thank you're done for this. And ready for the next number ID number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] About.
[CUSTOMER][NEUTRAL] Yes, next ID number which is
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you for your patience. 01989414 Mary Lima 7.
[AGENT][NEUTRAL] OK, hold on one moment. 01989, what was the rest?
[CUSTOMER][NEUTRAL] 01989414 Mary Lima 7.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Under [PII] with date of birth, [PII].
[AGENT][NEUTRAL] Alrighty, and thank you for that. And 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 and total bill?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] And bills for $348 even?
[AGENT][NEUTRAL] $348 even?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so the policy number that you provided terminated on [PII]. However, there is an active policy, policy number 2462857.
[AGENT][NEUTRAL] I'm going to look on that um policy to see if the claim was processed there.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] And it was, hold on one moment, I'm getting that information now.
[AGENT][NEUTRAL] And would this be the same provider as the others?
[CUSTOMER][NEUTRAL] Yes, which is the same gastrohealth?
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] That claim number is 354-51557.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] The patient's first name is [PII], right?
[AGENT][NEUTRAL] No, the patient's first name is [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The patient's name on this policy is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, one moment. I'm just on your portal, was unable to find the claim. I don't know the reason.
[AGENT][NEUTRAL] Are you under the correct policy?
[CUSTOMER][NEGATIVE] No, I was unable to
[CUSTOMER][NEUTRAL] No, the
[CUSTOMER][NEGATIVE] Portal is asking me for the claim ID number or the claim number which is 3545157. I just entered the same thing but I was unable to find the claim.
[AGENT][NEUTRAL] Are you still under the old? Go ahead.
[CUSTOMER][NEUTRAL] The patients
[CUSTOMER][NEUTRAL] As the patient's date of birth as I entered is [PII]. It is [PII], but I'm unable to find the claim, don't know the reason.
[AGENT][NEUTRAL] OK, would you like me to fax you a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] Afterwards, OK, one moment. Go ahead with the claim number done. When was, when did you deny the claim on?
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so did you have, so you have the claim number. The claim was denied on [PII]?
[AGENT][NEUTRAL] Because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Same like previous one patient uh supplemental policy gap policy plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, could you please do me a favor? Could you please fax a copy of EOB?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] To just the bill patient. Yeah, which is 615.
[CUSTOMER][NEUTRAL] 7773536, which is [PII]. Attention to my name, [PII]
[AGENT][NEUTRAL] All right. Hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hold on one moment, I'm just getting the fax.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I'll fax that over to you. You should be receiving that shortly and then the last member's policy number?
[CUSTOMER][POSITIVE] No, no, that's it. No, that's it for you. That's it for the day. Thank you for that, [PII]. Thank you for your patience and have a great weekend ahead. Bye-bye. Take care. I'm just expecting the copy of your it would be really helpful for me just to be the patience for the remaining balance amount, that's it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL [PII]. The fax is on the way to you and I hope you have a great weekend as well.
[CUSTOMER][NEUTRAL] A should the same bye bye.
[AGENT][NEUTRAL] Bye bye.