AccountId: 011433970860
ContactId: b6b098ea-0e4e-4c67-b76c-e4690db32faf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670599 ms
Total Talk Time (AGENT): 231432 ms
Total Talk Time (CUSTOMER): 163755 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/b6b098ea-0e4e-4c67-b76c-e4690db32faf_20250110T20:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from the provider's office for claim status.
[AGENT][POSITIVE] All right, perfect, [PII]. Let me help you out today. And do you mind if I get a great callback number?
[CUSTOMER][NEUTRAL] Yeah, that would be [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Wonderful. And what's your member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That would be
[CUSTOMER][NEUTRAL] 127446 M like Mary, L like Lima 8.
[AGENT][POSITIVE] Perfect and the numbers you said were 127446 and then ML 8?
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK. And I'm just worried that 127446 isn't long enough. Did I hear that correct?
[CUSTOMER][NEUTRAL] 127446 ML 8, yes.
[AGENT][NEUTRAL] All right, so I just don't have any policy number that matches that, but I can try searching for your patient under their first and last name if you'd like.
[CUSTOMER][NEUTRAL] Yeah, this is for.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Perlantis.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you spell the last name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, hang tight one more second.
[AGENT][NEUTRAL] Perfect. And could you verify um the date of birth for your insured?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, this is for [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. And I was able to pull it up with a different policy number. Can I give that to you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, I do have the policy number listed as 1121573.
[CUSTOMER][NEUTRAL] Is that all?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and could you please tell me your name?
[AGENT][NEUTRAL] Oh yes, it's [PII]
[CUSTOMER][NEUTRAL] And can I get the first initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure and then what is it?
[CUSTOMER][NEUTRAL] Could you please help me with the claim status?
[AGENT][NEUTRAL] Yeah, what's the data service for the claim we wanna look at today?
[CUSTOMER][NEUTRAL] D of service is on [PII].
[CUSTOMER][NEUTRAL] For total charge of 358 even?
[AGENT][NEUTRAL] All right, and I'm actually not showing any claim on file.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] I mean, um, the whole patient has no claims on file at all.
[CUSTOMER][NEUTRAL] 3:58.
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] [PII]. So this one has a different uh subscriber. I think she is the spouse of the, uh-huh.
[AGENT][NEUTRAL] Yes, I do see that.
[AGENT][NEUTRAL] I do see that, um, but I still am showing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No claim on file.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can I get your payer ID card payer ID?
[AGENT][NEUTRAL] Yeah, uh, the payer ID is 60801, and then just one moment, I am.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] do
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so it looks like they had another coverage with us at one point and I was able to find them there. I'm really sorry, it wasn't showing up the first time I looked for different coverages. So let me just
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Start that over. I'm going to search it underneath.
[AGENT][NEUTRAL] The coverage they had during that date of service 04-24-2024.
[AGENT][NEUTRAL] And what was that builded amount, my friend?
[CUSTOMER][NEUTRAL] 3:58 even.
[AGENT][POSITIVE] Perfect. OK, I do see that here um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 3149.
[AGENT][NEUTRAL] Perfect and the name of the provider on file for this claim?
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[AGENT][POSITIVE] Wonderful. Alright, I see we received your claim on 06-21-2024.
[AGENT][NEUTRAL] It looks like we processed the claim on 06-25-2024.
[AGENT][NEUTRAL] And then it looks like that claim number is 34731.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 49
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] And that claim was denied. It looks like it says that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So you're telling me the claim number is 3473149?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 347-3149. OK.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] The claim was denied.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Yep, and it stated that um office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, which type of policy is this?
[AGENT][NEUTRAL] Um, the policy, we are their secondary gap insurance.
[CUSTOMER][NEUTRAL] OK just a minute.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thanks for being
[CUSTOMER][NEUTRAL] Secondary gap.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What are the, what are the services that can be covered under this?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, let me look at their benefits for you. I do wanna let you know any benefit information I give you over the phone is just a verification of
[AGENT][NEUTRAL] Coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And actually hang tight, I'm gonna have to open up the policy document because it's not an active policy anymore.
[AGENT][NEUTRAL] Alright, I'm showing that their outpatient policies are, um,
[CUSTOMER][NEUTRAL] OK, and can I
[AGENT][NEUTRAL] For an hospital ER room, urgent care facility, surgery in a hospital outpatient facility or free-standing outpatient surgery center, diagnostic testing in a hospital outpatient facility or MRI facility, um,
[AGENT][NEUTRAL] Outpatient treatment in a mental or emotional disorder or outpatient treatment for a mental or emotional disorder in a hospital outpatient facility, physical therapy facility, or ambulance.
[CUSTOMER][NEUTRAL] Emergency can be also covered.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] OK, and can I get the call reference for this one?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much and you have a great rest of your day. Thank you.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Uh