AccountId: 011433970860
ContactId: 731a6b0d-8927-4346-8c45-8b33cd2d5990
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 748140 ms
Total Talk Time (AGENT): 279384 ms
Total Talk Time (CUSTOMER): 196333 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/731a6b0d-8927-4346-8c45-8b33cd2d5990_20250211T14:52_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, it's [PII] calling from provider office to claim theaters.
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim status. May I ask your name again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] [PII], thank you. And a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Oh, it's 01881626. M as in Lima, M as in Mike, number 8.
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to help you with that claim status. What is the date of service?
[CUSTOMER][NEUTRAL] It's [PII] with the bill amount of $599.
[AGENT][NEUTRAL] Alright, bear with me just one moment, [PII], the policy number that you gave me is an older policy number and it turned on 4121, checking to see if she has coverage for your data service.
[AGENT][NEUTRAL] She does have an active policy. Can I give you the correct policy number for that data service?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] As of [PII], her active policy number is 247.
[AGENT][NEUTRAL] 3171.
[CUSTOMER][NEUTRAL] Oh, it's 2473171.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] Uh, and may I know where.
[AGENT][NEUTRAL] And what was the name of the?
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] How many per minute it was active.
[AGENT][NEUTRAL] On [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] And no termination lead.
[AGENT][NEUTRAL] No termination date on file.
[AGENT][NEUTRAL] Now I do have a claim for that data service for that built out. What was the facility name?
[CUSTOMER][NEUTRAL] Oh, it's a Holy Cross Medical bill.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] So then it looks like we did receive that claim on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] And the 99204 was denied as office visits are not covered for the patient's plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And uh may I know what is the special plan?
[AGENT][NEUTRAL] It's a Medlink gap policy. It's secondary to their major medical.
[CUSTOMER][NEUTRAL] Uh, it's Medicare policy.
[AGENT][NEUTRAL] That's right. Medlink Gap.
[CUSTOMER][NEUTRAL] Oh, can you spell it for me?
[AGENT][NEUTRAL] Sure, it's M as in Mike, E as in Echo, D as in Delta, L as in Lima.
[AGENT][NEUTRAL] I as in India, N as in November, K as in Kilo.
[AGENT][NEUTRAL] Medlink
[AGENT][NEUTRAL] And then Gap GAP.
[CUSTOMER][NEUTRAL] Uh, it's like HMO or PPO plan.
[AGENT][NEUTRAL] It's like a supplemental plan to their major medical. No HMO PPO.
[CUSTOMER][NEUTRAL] And may I also have the claim number for this one?
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 5000.
[CUSTOMER][NEUTRAL] 355-0500
[AGENT][NEUTRAL] No, ma'am. I'm sorry, it's 355.
[AGENT][NEUTRAL] 5000. So it's 3 and then 3 consecutive 5s.
[AGENT][NEUTRAL] And 3 consecutive zeros.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] My pleasure to help you with that.
[CUSTOMER][NEUTRAL] And can answer.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Um, I also didn't catch up your name. Can you spell it for me?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII].
[CUSTOMER][NEUTRAL] So much and may I also have the call reference number for this member.
[AGENT][NEUTRAL] Caller reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. And I do have 2 more members. You can check with that one also.
[AGENT][POSITIVE] Yes, ma'am [PII], I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Oh, it's 10605184. M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] 10605184
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] And what is the patient's last name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Can you spell it?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] It's [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and did you give me the policy number? did you say?
[AGENT][NEUTRAL] 10605184.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me give you the correct policy number. I had to look it up by name. The correct policy number for [PII] is 016.
[AGENT][NEUTRAL] 05184.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is that data service please, ma'am?
[CUSTOMER][NEUTRAL] Uh, it's in [PII] with a bill amount of $355.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that facility name.
[CUSTOMER][NEUTRAL] Uh, it's on the same Holocaust Medical bills.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] that claim we received on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And that claim was denied.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's not a covered loss under the plan.
[AGENT][NEGATIVE] So it's not covered.
[CUSTOMER][NEUTRAL] Oh, it's same.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Under members plan name for this one also.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Like even is it office is it?
[AGENT][NEUTRAL] It is. Yes, ma'am.
[CUSTOMER][NEUTRAL] And may I also have this member's plan.
[AGENT][NEUTRAL] It's secondary Medin gap policy.
[CUSTOMER][POSITIVE] Thank you so much. And may I also have the PIN number?
[AGENT][NEUTRAL] Claim number is 3557611.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can we move to the next member?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Um, the next member ID is.
[CUSTOMER][NEUTRAL] 0247326 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] 247326
[CUSTOMER][NEUTRAL] Oh, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, this one, there's a number missing. What's that patient's last name?
[CUSTOMER][NEUTRAL] Oh, it's long.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It should, yes.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII] Thank you. Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me get that policy pulled up.
[AGENT][NEUTRAL] All right. Can I give you the correct policy number for [PII]?
[CUSTOMER][NEUTRAL] Ah yes.
[AGENT][NEUTRAL] Correct, policy number is 247.
[AGENT][NEUTRAL] 326 4.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And that data surface.
[CUSTOMER][NEUTRAL] Uh, it's [PII] with the bill amount of $599.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm checking.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Claim was received on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] And denied as office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah, even it's under the
[CUSTOMER][NEUTRAL] Same plan and members plan, right?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK then, and may I also have the pin number?
[AGENT][NEUTRAL] Claim number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] And that's OK. Thank you so much for asking me. Have a wonderful day.
[AGENT][POSITIVE] It's been such a pleasure to assist you with that claim status today. [PII], thank you for calling APL and I hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Bye, take care.
[AGENT][NEUTRAL] Bye-bye.