AccountId: 011433970860
ContactId: ec2eb5c2-6d7e-48a2-ba22-283612910915
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394619 ms
Total Talk Time (AGENT): 139301 ms
Total Talk Time (CUSTOMER): 113681 ms
Interruptions: 1
Overall Sentiment: AGENT=2.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/ec2eb5c2-6d7e-48a2-ba22-283612910915_20250131T20:20_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] Yeah, hi [PII]. Good afternoon. My name is [PII] and last name initial on [PII]. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK, let's help you with claim status today, [PII]. Do you mind if I get a good callback number from you real quick?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][POSITIVE] Thank you. I really appreciate that. And what is the policy number we're looking at today?
[CUSTOMER][NEUTRAL] Yeah, it's uh 01896543.
[AGENT][NEUTRAL] 543, you betcha.
[AGENT][NEUTRAL] And give me just a moment to get that pulled up for you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Perfect. Thank you so much for your patience, and if you could verify that member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect. I do see [PII] here. And what is the, do you have the claim number you want to look at or are you wanting me to start with the data service? OK, perfect. What's that data service, sir?
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] Date of sales.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $348 even.
[AGENT][NEUTRAL] 3:48 even you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And to make sure I got that date right, [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the name of the facility on file for that claim?
[CUSTOMER][NEUTRAL] OK. The facility name is Gastro Health LLC.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Perfect. Thank you, thank you. And I do have that claim here. It looks like we received it 10-22-2024. Looks like we processed it 10-24-2024. And I do show the claim here was denied. The reason stating is that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK. And when is the claim number?
[AGENT][NEUTRAL] Uh, oh, I'm sorry, I should have given that to you. My claim number is 3521587.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. And let's move to the plan.
[AGENT][POSITIVE] Yeah, absolutely. Let me put this note in real quick and I can help move on to the next one for you.
[CUSTOMER][NEUTRAL] So when you are ready, I can forward the claim number and member ID.
[AGENT][POSITIVE] No, I'm ready for that member ID for you, my friend.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Why? May I know the reason?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, uh, sorry for the inconvenience. Uh, so is there any chance let's move to another patient?
[AGENT][POSITIVE] Oh, I'm ready, yes.
[CUSTOMER][NEUTRAL] OK. The next member ID is 010 1 2nd.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] I provided the incorrect number ID.
[CUSTOMER][NEUTRAL] OK. Yeah. The 02518372 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. One moment while I get this side pulled up for you.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] Alright, and give me one second while that loads, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So sorry about that. That loaded and then I just had to sneeze. Um, OK, and your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Just give me a moment.
[CUSTOMER][NEUTRAL] OK. Uh, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect. I see [PII] here. Same thing we want to search for a data service. Is that correct?
[CUSTOMER][NEUTRAL] And I'll have
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you still, you wanna start?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][POSITIVE] You're good. I'm so sorry. I didn't mean to interrupt you.
[CUSTOMER][NEUTRAL] OK. Uh, the date of service is [PII] and the total charge $542 even.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, perfect. I see that claim here. It looks like your claim was received [PII]. The claim was processed [PII]. I show your claim number is 351-8941, and I do show that claim denied, same as the last one, office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. And can you please repeat again one more time? The claim number is 351.
[AGENT][NEUTRAL] 8941.
[CUSTOMER][POSITIVE] Yeah, thank you. And thank you for giving this information, [PII]. Have a nice day.
[AGENT][POSITIVE] My pleasure.
[AGENT][POSITIVE] You too. Take care, [PII]. Thanks.
[CUSTOMER][POSITIVE] Yeah, and happy weekend. Bye-bye.
[AGENT][POSITIVE] Likewise, take care bye bye.