AccountId: 011433970860
ContactId: 6e89ba00-c30e-4dac-91d4-c44770dd7bd2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1104079 ms
Total Talk Time (AGENT): 251983 ms
Total Talk Time (CUSTOMER): 175496 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/6e89ba00-c30e-4dac-91d4-c44770dd7bd2_20250417T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning. My name is [PII] and last termination for [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, [PII], I can check claim status for you sir. Can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is um the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[AGENT][NEUTRAL] OK, and then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, just give me a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Um, the policy number is 02566408.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient name is [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK, alright, let me look that up real quick.
[AGENT][NEUTRAL] Alright, it's trying to pull it in.
[AGENT][NEUTRAL] OK, and what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $348 even.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] OK, just give me a moment. It's loading.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] $53.41. So that is the remaining balance amount.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And primary paid, uh, primary deductible $132.41.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alright. I'm gonna put you on a quick hold while I look this claim up for us and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And it's gonna be 5341 or 348.
[AGENT][NEUTRAL] It's gonna be 357.
[AGENT][NEUTRAL] 357-4937.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, that's not it.
[AGENT][NEUTRAL] It's going to be 357-918-2.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] I appreciate you waiting for me, [PII]. This is [PII] and I've got the claim information for you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] The claim number is 357-918-2.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was it was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when the claim received it and claim did not date.
[AGENT][NEUTRAL] Let me look that up for you real quick.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And that's more than the patient.
[AGENT][NEUTRAL] OK, and what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, just give me a moment, it's loading.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And how many patients do we have?
[CUSTOMER][NEUTRAL] Uh, actually, total of 3 claims, you already provided 1 and 2 more is there.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID is 01887307 M for Mary, L for Lima, 8.
[CUSTOMER][NEUTRAL] And the patient name is [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK, let me look up that patient real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I have Roger pulled up. Can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge $1,962 even.
[AGENT][NEUTRAL] 1962.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] And the remaining balance is $40 even.
[AGENT][NEUTRAL] OK. And then what is the name of the facility?
[CUSTOMER][NEUTRAL] Same gastrohealth.
[AGENT][NEUTRAL] Gastro Health. OK. All right. I'm gonna put you on a quick hold again while I look up this claim and I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1962.
[AGENT][NEUTRAL] See if there's any more.
[AGENT][NEUTRAL] 357.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 248.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me again [PII] so I do have the claim number for you.
[AGENT][NEUTRAL] The claim number is 3573248 and the claim was denied because we received the claim after the termination date of the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy terminated on [PII], and there are no other active policies for this member.
[CUSTOMER][NEUTRAL] May I know the effective date?
[AGENT][NEUTRAL] The effective date was also [PII].
[CUSTOMER][NEUTRAL] OK. Thank you. Let's move to the last claim.
[AGENT][NEUTRAL] OK, can you give me the
[AGENT][NEUTRAL] Uh, patient's name, date of birth, and policy number, sir.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Uh, can you spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] To, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Um.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] The next claim num the member ID is 01723507.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the member's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, it's, sorry.
[CUSTOMER][NEUTRAL] [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII], yeah, sorry. [PII]. And the total charge $542 even.
[AGENT][NEUTRAL] $540 and can you repeat that data service one more time for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge $542 even.
[AGENT][NEUTRAL] Thank you, sir. And then it's also for gastrohealth?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I'm gonna put you on a quick hold while I look up this claim real quick.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find the claim on file. I do show that this policy did terminate on [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There are no policies active, yes, there are no policies active for the year of [PII].
[CUSTOMER][NEUTRAL] Terminator on?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, you provided the effective date, right? [PII] and may I know the termination date.
[AGENT][NEUTRAL] Uh, let me give that to you again.
[AGENT][NEUTRAL] The effective date of the policy was [PII].
[CUSTOMER][NEUTRAL] OK, [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for giving this information. Have a nice day.
[AGENT][POSITIVE] You too. You have a wonderful day too. Yes, sir. You can use my name and today's date. And is there anything else that I'd be able to help, help you with before we go?
[CUSTOMER][NEUTRAL] And may I know the call reference number?
[CUSTOMER][NEUTRAL] Uh, no, thanks. That's it.
[AGENT][POSITIVE] OK, have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Bye-bye, sir.