AccountId: 011433970860
ContactId: 1f5793ee-cf8e-4b0f-8de3-4bb0a4b77a90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478119 ms
Total Talk Time (AGENT): 168619 ms
Total Talk Time (CUSTOMER): 143377 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/1f5793ee-cf8e-4b0f-8de3-4bb0a4b77a90_20250204T18:33_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from provider's office to check on a claim status.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status. And sir, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, sure. It's [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02538211, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] Uh, I'm looking for a claim status for date of service [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's for $714 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it's Vital MD Group Holding LLC.
[AGENT][NEUTRAL] Thank you, and I'm sure you received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3551366.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just ask for the member's plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is the plant's name?
[AGENT][NEUTRAL] This is a Medlink supplemental insurance policy.
[CUSTOMER][NEUTRAL] Can you spell out the first one?
[AGENT][NEUTRAL] Sure, M as in Mary, E like Edward, D like dog.
[AGENT][NEUTRAL] L like Larry, I like igloo, N like Nancy, K like kite, S like Sam.
[CUSTOMER][POSITIVE] Thank you. And also can I get the effective date for the policy?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Affect you and terminate for the policy.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I do have another claim for different patient. Before that, can I get the call reference number for this one?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you. Just give me a minute for the next one.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, more to claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, are you ready for the member ID?
[AGENT][NEUTRAL] Um, hold on one moment, I'm noting this policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the next one's policy number?
[CUSTOMER][NEUTRAL] It is 231 43.
[CUSTOMER][NEUTRAL] That's it. It's just 5 digits.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's just a 5 digit, uh it's 23143.
[AGENT][NEUTRAL] Mm, that may be the group number. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the member's name?
[CUSTOMER][NEUTRAL] It is [PII]. Do you want me to spell that out?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The first name is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 247.
[AGENT][NEUTRAL] 3107.
[AGENT][NEUTRAL] And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, it is for [PII]. The bill amount $175 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh, the member ID is just 2473107. That's it on.
[CUSTOMER][NEUTRAL] Does anything M as in Mike, M as in
[AGENT][NEUTRAL] You can add a 0 and you can put a 0 in the beginning if you like. The ML 7 or 8 is on the cards. It's the number that's the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And I just located the claim, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's the same vital and the group holding LLC.
[AGENT][NEUTRAL] I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3547436.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. And is the member's plan same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, what is the effective date for this policy?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh it's still active, right?
[AGENT][NEUTRAL] Yes, it's still active.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK, so I guess that's it from my side. Thank you so much for helping me out.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, you're welcome. Bye bye.