AccountId: 011433970860
ContactId: 199900d7-3a4e-4081-8a55-4b45bda29eeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1207979 ms
Total Talk Time (AGENT): 224431 ms
Total Talk Time (CUSTOMER): 259694 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/199900d7-3a4e-4081-8a55-4b45bda29eeb_20250113T16:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from provider's office to check on claims.
[AGENT][NEUTRAL] OK, I can help you with claims. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Oh yes, that is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, [PII]?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] And then the policy number, please?
[CUSTOMER][NEUTRAL] 19336.
[AGENT][NEUTRAL] OK, what's the rest of the policy number?
[CUSTOMER][NEUTRAL] Actually, I don't have that much only. Just give me a moment.
[CUSTOMER][NEUTRAL] Oh, that is group number. Just a second.
[CUSTOMER][NEUTRAL] Uh, can you check with name and date of birth?
[AGENT][NEUTRAL] OK, um, can you spell uh [PII]'s last name for me please?
[CUSTOMER][NEUTRAL] That is [PII]
[AGENT][NEUTRAL] OK, let me see if I can find them by the name.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not pulling in by the name. Do you have the client number?
[CUSTOMER][NEUTRAL] Mm, just a second.
[CUSTOMER][NEUTRAL] Uh, no, actually, I don't have claim number also. But we did receive payment. No, just a second.
[CUSTOMER][NEUTRAL] I don't have insurance card on that. It is showing that it is as a group ID.
[CUSTOMER][NEUTRAL] Uh, inpatient benefit certificate number. Is that the member ID?
[AGENT][POSITIVE] Yes, yes, please.
[CUSTOMER][NEUTRAL] That is 152.
[CUSTOMER][NEUTRAL] 7444 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is, just a second.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $1310 even.
[AGENT][NEUTRAL] OK, and what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $70.
[AGENT][NEUTRAL] OK and the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] That is vital MD Group Holding.
[AGENT][NEUTRAL] OK, Miss [PII], I'm gonna put you on a brief hold while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1527444.
[AGENT][NEGATIVE] Well she spelled it wrong.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Um, Amtrak.
[AGENT][NEUTRAL] 1310.
[AGENT][NEUTRAL] 789 10.
[AGENT][NEUTRAL] Let's 352.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the claim number is 352.
[AGENT][NEUTRAL] 3379.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh, can I have fax number?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Uh, actually, there is one more date of service for the same member.
[AGENT][NEUTRAL] OK, what is that data service?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] 370.
[AGENT][NEUTRAL] And then what is the charge after primary paid their part?
[CUSTOMER][NEUTRAL] $70 even.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Oh yes, right.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'm gonna look that claim up for you. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I did find the claim for you and the claim number is 3546951.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because this policy only covers benefits for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, just a second.
[CUSTOMER][NEUTRAL] Only cover accident or sickness.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the service is not under that?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Mm, OK, OK, no issues.
[CUSTOMER][NEUTRAL] Uh, I do have 2 more claims. Just give me a moment.
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] Yeah, the next
[CUSTOMER][NEUTRAL] Patient name is, uh, uh just give me a moment. I'd like to check the ID.
[CUSTOMER][NEUTRAL] Yeah. 0162.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 29
[AGENT][NEUTRAL] OK, and what's the patient's name?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the date of birth, I.
[AGENT][NEUTRAL] All right, let me
[AGENT][NEUTRAL] Let me pull in the policy real quick.
[CUSTOMER][NEUTRAL] Mm go ahead.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, what is Olga's data service?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Uh, actually, claim is split in 21 is $1310 even.
[AGENT][NEUTRAL] And that's for data service of [PII] and what's the other amount?
[CUSTOMER][NEUTRAL] For uh.
[CUSTOMER][NEUTRAL] That is $175 even.
[AGENT][NEUTRAL] OK, and then what is the charges after primary paid their part?
[CUSTOMER][NEUTRAL] Uh, for $1310 that is $99.18. And for $1,075 it is 1481 cents.
[AGENT][NEUTRAL] OK and then what is the name of the facility?
[CUSTOMER][NEUTRAL] Vital MD Group Holding.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold again. I'm gonna check this claim for you. I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I have both of those claim numbers for you.
[AGENT][NEUTRAL] The first one is 352.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 863 7.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the second one is 3,543,570.
[AGENT][NEUTRAL] And both of them were denied because office visits are not covered under the insurance policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, may I know what is the plan name of member?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have one more claim. Just give me a moment, please.
[CUSTOMER][NEUTRAL] 8 2024.
[CUSTOMER][NEUTRAL] That is 024.
[CUSTOMER][NEUTRAL] 50102.
[AGENT][NEUTRAL] OK, and what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is the charge amount?
[CUSTOMER][NEUTRAL] That is $1300 even.
[AGENT][NEUTRAL] And then the day of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull her policy in real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this claim up for you. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII]. This is [PII] back with you again. So looking at claim number 3530725, the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's say not cover, uh.
[CUSTOMER][NEUTRAL] Again, Medli.
[AGENT][NEUTRAL] The mailing address is APL Claims.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, uh, no, no, no. Actually, uh, policy name, plan name.
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] OK, OK, no issue. Can I have caller's number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] Lastation.
[AGENT][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And today's date?
[AGENT][NEUTRAL] Today in today's date, yes.
[CUSTOMER][NEUTRAL] Today
[CUSTOMER][POSITIVE] OK then um OK then thank you so much have a great day.
[AGENT][POSITIVE] You too, thank you for calling APL you have a great day too.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye bye.