AccountId: 011433970860
ContactId: c863812d-c83f-44d3-9a5c-c205d38ff711
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645960 ms
Total Talk Time (AGENT): 142288 ms
Total Talk Time (CUSTOMER): 94594 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/c863812d-c83f-44d3-9a5c-c205d38ff711_20250214T20:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is how may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility or the provider you're calling from?
[CUSTOMER][NEUTRAL] It's Gastro Health LLC.
[CUSTOMER][NEUTRAL] And uh do you need the NPI?
[AGENT][NEUTRAL] No, we don't need that. Thank you, Mr. [PII]. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Well, uh, it's 194.
[CUSTOMER][NEUTRAL] 0409.
[AGENT][NEUTRAL] OK, thank you one moment let me pull this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. And the date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Alright, and what is the date of service and the amount of the claim?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, yeah, sorry.
[AGENT][NEUTRAL] The date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge is 348.
[AGENT][NEUTRAL] OK, so that's 1210 of 24 for 348.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can find it.
[AGENT][NEUTRAL] For the future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Am.
[CUSTOMER][NEUTRAL] Sorry, sorry, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK, yeah, please.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Um, it's gonna be one more minute. I'm still searching for your phone.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] They can't remember that.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] I'm there.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] OK, we received the claim on [PII], processed the claim on [PII], and the claim was denied. The denial reason is that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, are not covered.
[CUSTOMER][NEUTRAL] By policy. What kind of policy does the patient have?
[AGENT][NEUTRAL] This is a 2nd, uh, secondary supple, no, this is a limited indemnity plan.
[CUSTOMER][NEUTRAL] Limited intermediate plan, sorry?
[AGENT][NEUTRAL] Mhm. Bear with me just a second.
[AGENT][NEUTRAL] OK, now, this is a secondary supplemental plan to the major medical, so this is a secondary plan.
[CUSTOMER][NEUTRAL] Yeah, please.
[CUSTOMER][NEUTRAL] Supplemented the plan and uh it's a limited benefit plan, right?
[AGENT][NEUTRAL] It is limited, yes, and this one doesn't have office visit benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] The claim number on this one is 3551702.
[CUSTOMER][POSITIVE] So very true.
[CUSTOMER][NEUTRAL] Can you 50 for me?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] to your attention.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, I went, um, thank you for holding and being patient for me. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you spell your name, please?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] And the call reference.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, thank you. OK. Thank you so, thank you so much for your assistance. Have a nice day. Happy weekend.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] You're welcome. You as well, Mr. [PII]. Thank you for calling ATL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye