AccountId: 011433970860
ContactId: 2bf976a0-4cd0-4eff-b59f-4bcc36d23bcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308269 ms
Total Talk Time (AGENT): 114052 ms
Total Talk Time (CUSTOMER): 104088 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/2bf976a0-4cd0-4eff-b59f-4bcc36d23bcb_20250417T18:09_UTC.wav
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[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII] calling from provider's office regarding our claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and can you repeat your name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, I'm [PII].
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] with [PII] of [PII].
[AGENT][NEUTRAL] OK, the phone went in and out. I heard [PII] and then the extension.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] It's the callback number is [PII] with [PII] of [PII]. OK?
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, it's my policy number is 194. It's 1940409.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's first name is uh.
[CUSTOMER][NEUTRAL] It's uh [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Day of services [PII] with the bill amount of $348 even.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm not showing that there's a claim on file, but also this is her previous policy. Let me look on the active policy. Um, that policy number is 2557225.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's been active since [PII].
[AGENT][NEUTRAL] And hold on one moment while I search that policy.
[CUSTOMER][POSITIVE] Good good.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure, provider's office on the plane is Gas Gastro Health LLC.
[AGENT][NEUTRAL] Thank you for that, and I'm sure you received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0099.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII]. It was in, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, stating the uh the CPT 99214 is not covered under that member's plan. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No, could you please help me the member's plan name?
[AGENT][NEUTRAL] Is the Medlink supplemental gap insurance?
[CUSTOMER][NEUTRAL] Main supplement, Main supplementally.
[CUSTOMER][NEUTRAL] Gap insurance, right?
[AGENT][NEUTRAL] Supplemental gap insurance.
[CUSTOMER][NEUTRAL] Supply.
[CUSTOMER][NEUTRAL] gap insurance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, got it. Can you please send me the copy of your fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry, [PII].
[AGENT][NEUTRAL] And who should I put the attention to?
[CUSTOMER][NEUTRAL] You can add attention to my name [PII]
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so I'll go ahead and fax this over to you now. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, nothing else. I need to call reference, [PII].
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] OK, I just wanted to confirm the claim number once again. The claim number is 3580099. Am I right?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you, [PII], that's all the information I need and thank you for assistance. Bye for now.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.