AccountId: 011433970860
ContactId: b8f336d5-c601-4559-be5a-552981f521cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 155759 ms
Total Talk Time (AGENT): 71428 ms
Total Talk Time (CUSTOMER): 53358 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/b8f336d5-c601-4559-be5a-552981f521cb_20250206T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. I'm calling from Valdoto Orthopedics in the billing department, and, uh, we have a claim here that I wanted to review with you.
[AGENT][NEUTRAL] OK, I'm happy to check on a claim. Do we have the claim number, policy number?
[CUSTOMER][NEUTRAL] The claim number is 3556911.
[AGENT][POSITIVE] All right, thank you for that. Let me pull this up here.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And then if I could just get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much. So let's see.
[AGENT][NEUTRAL] Looks like claim was denied stating office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK, is this the spouse's policy or hers?
[AGENT][NEUTRAL] So, she is a dependent on the policy. [PII] is the holder. This is the secondary insurance.
[CUSTOMER][NEUTRAL] Correct, so, so the no office visits for any providers is covered by this insurance?
[AGENT][NEUTRAL] Correct under the member's plan there were no there are no office visits covered, correct.
[CUSTOMER][NEUTRAL] That's odd.
[CUSTOMER][NEUTRAL] OK, so if he goes to a doctor, he can't, he don't have, he can't, he don't have any office visit coverage.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct, this plan doesn't cover the office visit fee. um, we have some that do some that don't. This one doesn't unfortunately.
[CUSTOMER][NEUTRAL] OK, and what was your first name again?
[AGENT][NEUTRAL] My name is [PII], which is [PII]
[CUSTOMER][NEUTRAL] And do you have, do y'all give a reference numbers or just the date and time?
[AGENT][NEUTRAL] Yeah, absolutely. Well, it's my name with my last initial and then just today's date. My last initial is [PII].
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What type of policy is it like a limited?
[AGENT][NEUTRAL] So it's called, yeah, it's a meddling plan is what it's called, um.
[CUSTOMER][NEUTRAL] But barely.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Some people call it gap.
[CUSTOMER][POSITIVE] Got you. OK, all right, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.