AccountId: 011433970860
ContactId: 4b069ea4-b337-4399-9c87-1919e20df9cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418160 ms
Total Talk Time (AGENT): 122118 ms
Total Talk Time (CUSTOMER): 157774 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/4b069ea4-b337-4399-9c87-1919e20df9cf_20250320T18:21_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, [PII]. I'm uh [PII] calling from provider's office to know the status of the claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] with the extension of [PII]. And could you please spell me your name for my documentation purpose?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] [PII] OK. Hi, [PII].
[AGENT][NEUTRAL] Hey, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, it's 02411110, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] 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] Yeah. Person's first name, last name is [PII]. And the date of birth is [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 you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] It's $221 even.
[AGENT][POSITIVE] 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 Cleveland Clinic, Florida.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing we received the claim on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 0827
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under this policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know patient policy type?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] So this is the insured Medlink policy. It's a supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] Uh, uh, could you please go a little slower? It's insured.
[AGENT][NEUTRAL] Oh, no, no, I was saying the insured policy is a Medlink.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Medlink
[AGENT][NEUTRAL] Supplemental.
[CUSTOMER][NEUTRAL] Supplemental.
[AGENT][NEUTRAL] Gap
[CUSTOMER][NEUTRAL] Gap
[AGENT][NEUTRAL] Yes, G like girl, A like apple, P like Papa.
[CUSTOMER][NEUTRAL] Yeah, OK. Yeah.
[AGENT][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] OK, fine. And uh may I know, uh, OK, because of this, this one, you won't cover office visit, right?
[AGENT][NEUTRAL] Right, because of the member's policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please hold, uh, could you please wait while I check in my system?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah. Sorry for taking your time.
[AGENT][NEUTRAL] Oh, no, you're fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Actually, before and after the date of service, we got payment from insurance, I think, one moment.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. I really didn't get, OK.
[CUSTOMER][NEUTRAL] Fine.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK. Yeah. I checked in my system. I we don't get any payment previously. OK, fine. And uh
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I have the
[CUSTOMER][NEUTRAL] Call reference number?
[CUSTOMER][NEUTRAL] Uh, OK. Before that, is there any chances that we could submit corrected claim?
[AGENT][NEUTRAL] Well, the policy doesn't cover office visits, so unless the place of service changes, it would be the same outcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. If you change the place of service, is there any option?
[AGENT][NEUTRAL] Well, uh, you shouldn't be able to if it was done in an office, then it should stay as an office visit.
[CUSTOMER][NEUTRAL] OK, sure. OK, sir. OK.
[AGENT][NEUTRAL] All right. And [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] Yeah, but it's OK. Uh, for my documentation purpose, could you please, uh, OK, no problem. Uh, call uh can I get the call reference number?
[AGENT][NEUTRAL] Sure. Um, so there's no call reference number, but you can use my name in today's date. So that's [PII] to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And it's 03.
[CUSTOMER][NEUTRAL] One moment. 0320.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 2025, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, sure. OK. Thank you for your kind and help, [PII]. Have a beautiful day.
[AGENT][POSITIVE] You're very welcome, [PII]. You also, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No problem. No, I got my information. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Yep bye.