AccountId: 011433970860
ContactId: 6f18b36b-8534-4c0b-b4bf-7f1b71751dbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265190 ms
Total Talk Time (AGENT): 87844 ms
Total Talk Time (CUSTOMER): 105059 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/6f18b36b-8534-4c0b-b4bf-7f1b71751dbe_20250114T18:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, sir. My name is [PII] calling from [PII]'s office to check on a claim. Can you help me with that?
[AGENT][POSITIVE] Yeah, I'm happy to check on the claim for you today, [PII]. What is the patient's policy number, please?
[CUSTOMER][NEUTRAL] Sure. The member's policy number.
[CUSTOMER][NEUTRAL] S 01923358. M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you so much. And may I have a good callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] It direct line.
[AGENT][POSITIVE] Thank you so much. What is the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] For this one of services.
[CUSTOMER][NEUTRAL] [PII], with the total amount $334.56.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it looks like we did receive this claim, uh, the claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. Do you have any specific reason?
[CUSTOMER][NEUTRAL] Like, for what reason the services are not covered under the member's plan?
[AGENT][NEUTRAL] It's the plan type that they have. It just does not cover an office visit.
[CUSTOMER][NEUTRAL] OK. As per plan, office visit is not covered, you are saying, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, do you have any idea which type of plan member have?
[AGENT][NEUTRAL] This is a secondary insurance, so it covers deductible, co-pay, co-insurance. The primary does not. It's a gap insurance.
[CUSTOMER][NEUTRAL] OK. But, uh, OK.
[CUSTOMER][NEUTRAL] So, Medicare has left to his uh.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Copay has been written to you. So, as per plan, the primary copay is not covered for this member, right?
[AGENT][NEUTRAL] Correct, because this plan does not cover the office visit fee.
[CUSTOMER][NEUTRAL] Of a visit fee. OK.
[CUSTOMER][NEUTRAL] When was the claim received? Can I get the date?
[AGENT][NEUTRAL] Claim has received [PII].
[CUSTOMER][NEUTRAL] Process on.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, what was the process date, claim process date?
[AGENT][NEUTRAL] Oh, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] It's 345.
[AGENT][NEUTRAL] 9770.
[CUSTOMER][NEUTRAL] OK. And the claim means it is not covered because as per plan, office visit fee is not covered. So that's the reason, uh, the claim has been not paid. So we just need to bill this whatever amount need to bill to the patient, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We're not able to advise on the patient responsibility that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Sure. Can I get the reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] OK, thank you, sir. Have a great information and have a good day. Bye-bye.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.