AccountId: 011433970860
ContactId: 38909643-f968-4bb0-b32f-abf491953764
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260250 ms
Total Talk Time (AGENT): 119723 ms
Total Talk Time (CUSTOMER): 101990 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/38909643-f968-4bb0-b32f-abf491953764_20250108T18:16_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from the Texas Digestive Disease Consultants, and I'm looking for the claim status with a few specific questions.
[AGENT][POSITIVE] OK, yeah, um, I would love to help you with some clean stuffs today, [PII], and
[AGENT][NEUTRAL] Do you mind if I really quickly get a good call back number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful, thank you so much. And what is that member's policy number?
[CUSTOMER][NEUTRAL] 02464971 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] Thank you, give me a moment to get this patient pulled up for you today, and while that's loading, I do just wanna clarify, were you calling because you were needing further information on a claim status like an EOB or were you calling to just get general claim status?
[CUSTOMER][NEUTRAL] Uh, I need any, uh, more information on the denied claim.
[AGENT][NEUTRAL] OK, perfect. And may you verify for me the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Last name is [PII], first name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect thank you so much I appreciate that and then what is the claim number we're wanting to look at today?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, one moment, it is the claim number.
[CUSTOMER][NEUTRAL] Here is the reference number is mentioned in the EOB.
[CUSTOMER][NEUTRAL] Which is 02.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 649-7.
[AGENT][NEUTRAL] Unfortunately I won't be able to look it up with a reference number, but I can just search for it for you by date of service, no worries. What's the date of service on the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I got the claim number 3513867.
[AGENT][NEUTRAL] Sorry, 351-386-7, did I hear that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me try to find that for you.
[AGENT][NEUTRAL] And could you verify for me please just the name of the provider on that claim so I can make sure I have the right one pulled up.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Provider name is Texas Digestive Disease Consultants or you need a rendering provider name.
[AGENT][NEUTRAL] Maybe I'm so sorry. Um, the name of the facility?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Texas Digestive Disease Consultants and uh there is a facility name is.
[CUSTOMER][NEUTRAL] Gastronology Associates of Florida.
[AGENT][NEUTRAL] OK, perfect. So um I do have the right claim that is wonderful and it looks like the claim was denied. The reason stating is that the office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] So your patient does have benefits for treatment done in an office setting, but not for the administrative charge.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, the office visit is not covered under the patient's plan, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK. And what type of plan patient have?
[AGENT][NEUTRAL] Uh, this is their secondary gap insurance.
[CUSTOMER][NEUTRAL] plan type of the member.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] It's uh the name of the plan is Medin.
[CUSTOMER][NEUTRAL] Meddling
[CUSTOMER][NEUTRAL] OK. And what is the call reference number? So my bill this amount to the patient?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yes, so the call reference number is my name [PII], first initial last name B [PII], and then today's date and then as far as patient responsibility goes, APL uh does not make any comment on patient responsibility. We cannot determine that.
[CUSTOMER][NEUTRAL] You see that's.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. Bye-bye.
[AGENT][POSITIVE] Bye bye. Thank you, [PII].
[CUSTOMER][NEUTRAL] What