AccountId: 011433970860
ContactId: 09497430-3151-41c8-9e6d-c3f10f3a5add
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424829 ms
Total Talk Time (AGENT): 112650 ms
Total Talk Time (CUSTOMER): 124907 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/09497430-3151-41c8-9e6d-c3f10f3a5add_20250513T20:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and I'm calling to know about a claim. Can you please give me your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII] and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, and last name is [PII].
[AGENT][NEUTRAL] OK, and you say you're calling for claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the policy number, please?
[CUSTOMER][NEUTRAL] It is 01852088 M. Mary, L Lima, number 8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Data service is [PII] and the charge amount is $500 even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] It is $30 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, don't show we received the claim for that data service and you said [PII]?
[CUSTOMER][NEUTRAL] No, it is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Vital MD Group Folding LLC.
[AGENT][NEUTRAL] Uh, show that claim process as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK. You mean it is dinner?
[AGENT][NEUTRAL] Yes, office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Can you give me the reason why it is not covered?
[AGENT][NEUTRAL] Because the patient's policy with our company does not cover office visits, so office visit charges are not covered under the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, OK. mm.
[CUSTOMER][NEUTRAL] Oh, wait a moment, please. Can you just hold for a minute?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, can you give me the patient's plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, Metlink. OK. And can you give me uh which is covered by the patient plan?
[AGENT][NEUTRAL] The policy covered services performed in an outpatient facility or inpatient in the hospital.
[CUSTOMER][NEUTRAL] By the patient policy.
[CUSTOMER][NEUTRAL] Covered for out uh inpatient hospital and
[AGENT][NEUTRAL] An outpatient.
[AGENT][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so can you please give me the claim number?
[AGENT][NEUTRAL] 3482936.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the call reference number?
[AGENT][NEUTRAL] You may use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, yeah, wait a moment, wait a moment, please. I have one more thing.
[AGENT][NEUTRAL] For the same patient or a different patient?
[CUSTOMER][NEUTRAL] Same patient.
[AGENT][NEUTRAL] OK, date of service and amount of the charge.
[CUSTOMER][NEUTRAL] Yeah, wait a moment.
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], and the total charge is $685 even.
[AGENT][NEUTRAL] Balance after primary.
[CUSTOMER][NEUTRAL] $35 even.
[AGENT][NEUTRAL] You said what was the date of service again?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Same provider.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we have not received the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the, uh, can you please give me your mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 95. And the Per ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for this the call reference number?
[AGENT][NEUTRAL] We, you can use my name in today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you. OK. It's very helpful. Thank you for your assistance. Have a great day. Bye for now.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye.