AccountId: 011433970860
ContactId: 9deb5955-695a-4f7f-9323-b7d5680257cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340399 ms
Total Talk Time (AGENT): 112343 ms
Total Talk Time (CUSTOMER): 102066 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/9deb5955-695a-4f7f-9323-b7d5680257cd_20250328T18:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from Portal office on behalf of Gastro with Orlando check on a claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] OK, the policy number is 60801.
[AGENT][NEUTRAL] OK, so that's uh that's actually our payer ID that's not gonna be a policy number um do you maybe have their social I could search for them that way?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] One moment let me check.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, I don't have the social. I do have the member's name, date of birth, and the phone number.
[AGENT][NEUTRAL] Um, we could try searching, uh, with their name if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Yeah, first name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last name is [PII] [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And what state does [PII] live in?
[CUSTOMER][NEUTRAL] Or live in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you have his date of birth?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK, I think I found him.
[AGENT][NEUTRAL] Alrighty, what was the date of service for this claim, [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And that bill out, please.
[CUSTOMER][NEUTRAL] And the total amount is for $175 even.
[AGENT][POSITIVE] Got it thank you one moment.
[AGENT][NEUTRAL] OK, so we did receive this claim at the end that we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, and when last time was it?
[AGENT][NEUTRAL] Uh, this claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Also, would you like me to give you that correct policy number before we go any further, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, one moment, let me correct that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, what's the policy number on that?
[AGENT][NEUTRAL] That's 02361597.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02361597.
[AGENT][NEUTRAL] That's correct, and then you needed the claim number?
[CUSTOMER][NEUTRAL] Yes, the claim number.
[AGENT][NEUTRAL] Yes, that's 356-547-2.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and you said that the claim was denied that the office visit is not covered under the patient's benefit plan, right?
[AGENT][NEUTRAL] It
[AGENT][POSITIVE] Correct, yes, that's correct.
[CUSTOMER][NEUTRAL] And what type of a plant does the patient have?
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] So secondary medical policies do not cover the office visits.
[AGENT][NEUTRAL] It does not cover office visits now.
[CUSTOMER][NEUTRAL] One moment let me check using other payment receipt for other any other data of services for the patient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We got that
[CUSTOMER][NEGATIVE] And you better find another patient responsible then.
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, so the claim is also not under the patient responsibility.
[AGENT][NEUTRAL] We don't say what is patient responsibility, that's up to the provider.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks for that.
[CUSTOMER][NEUTRAL] And could you please repeat your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, thanks for the camera. And is there a reference of this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you at the end?
[CUSTOMER][POSITIVE] No, that's it for today. Thanks for having our assistance. Have a great take care. Bye-bye.
[AGENT][POSITIVE] Of course, thanks for calling ATL. You too. Bye bye.