AccountId: 011433970860
ContactId: 359b5a34-956d-40d7-97a6-225121fd5c85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411309 ms
Total Talk Time (AGENT): 166127 ms
Total Talk Time (CUSTOMER): 145827 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/359b5a34-956d-40d7-97a6-225121fd5c85_20241231T14:55_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] Hi, this is [PII] calling from provider's office. I would like to check the claim status for a patient.
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim status, [PII]. What is a good call back number?
[CUSTOMER][NEUTRAL] My number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number is 025.
[CUSTOMER][NEUTRAL] 630.
[CUSTOMER][NEUTRAL] 62
[AGENT][NEUTRAL] And the patient's name and date of birth please, ma'am.
[CUSTOMER][NEUTRAL] Patient's name [PII] and date of birth on [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And I understand you're needing claim status for [PII]. It would be my pleasure to assist you. What is that data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of service on [PII] and the total bill amount on the claim is $189.60.
[AGENT][NEUTRAL] Thank you and what is the facility name please ma'am?
[CUSTOMER][NEUTRAL] I'm calling from Florida Foot and Ankle Associate LLC.
[AGENT][POSITIVE] Thank you, [PII], and it would be my pleasure to assist you with that claim information. [PII], I am showing that we received that claim on [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied as office visits are not a covered benefit per the guidelines of the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can we bill this to the patient?
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][NEUTRAL] OK, so can I have the patient plan name and plan type?
[AGENT][NEUTRAL] The plan name is the Medlink gap policy.
[CUSTOMER][NEUTRAL] I'm sorry, could you please repeat that once more?
[AGENT][NEUTRAL] Medlink MED.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Meddling policy.
[AGENT][POSITIVE] That's correct. It's a gap policy, Medli gap.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] Actually, I have 2 more members.
[CUSTOMER][NEUTRAL] Uh, yes, please.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 261 7.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure, and I'm ready for the next policy number whenever you are, [PII].
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] The next policy number 021.
[CUSTOMER][NEUTRAL] 387.
[CUSTOMER][NEUTRAL] 57
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name, [PII], and date of birth on [PII].
[AGENT][NEUTRAL] Thank you and that date of service?
[CUSTOMER][NEUTRAL] Date of service on [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is 311.
[CUSTOMER][NEUTRAL] $311.67.
[AGENT][NEUTRAL] Same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], that claim we received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now the 992.
[AGENT][NEGATIVE] 03 was denied as office visits not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The 73,610.
[AGENT][NEUTRAL] Was primary insured's primary insurance provided full benefits, therefore, there are no benefits payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I have the patient plan name for this one?
[AGENT][NEUTRAL] It is a a Medlink gap policy also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, I have one more member. Is that OK for you?
[AGENT][NEUTRAL] It's fine. What is that policy number?
[CUSTOMER][POSITIVE] Thank you so much. The next policy number?
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 576.
[CUSTOMER][NEUTRAL] 27
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] M's name, [PII] and date of birth on [PII].
[AGENT][NEUTRAL] Thank you. And what is that data service?
[CUSTOMER][NEUTRAL] D of service on [PII] and the total bill amount is $236.24.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And denied as office visits are not covered for the guidelines of the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2767.
[CUSTOMER][NEUTRAL] Um, is, is this number also have the same plan?
[AGENT][NEUTRAL] He, he does, she does the meddling gap.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for confirming that.
[AGENT][POSITIVE] My pleasure. Anything else I can help you with? Sure. The call reference number is my name and today's date. I spell my name [PII], it was a pleasure to assist you with that claim status today. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Can I have a call reference number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And I'm done with this. Thank you so much for your time.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a lovely day and happy New Year.
[CUSTOMER][NEUTRAL] Same to you. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.