AccountId: 011433970860
ContactId: 242896d8-7244-4991-86c8-267595ec12bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 601299 ms
Total Talk Time (AGENT): 164837 ms
Total Talk Time (CUSTOMER): 226337 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/242896d8-7244-4991-86c8-267595ec12bb_20250129T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. Good morning. My name is [PII]. I'm calling from provider's office to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Um, 33 claims.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] [PII]. Uh, and, and now we have extension [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, uh 022.
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] 779
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Um, [PII] and the bill amount is $400 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, it's Vital MD Group Holding LLC.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 3037.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Because the service is not
[CUSTOMER][NEUTRAL] Up to
[AGENT][NEUTRAL] The services, go ahead.
[CUSTOMER][NEUTRAL] Uh, on which date? OK, OK.
[CUSTOMER][NEUTRAL] Go on, on [PII].
[AGENT][NEUTRAL] [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's it's not.
[CUSTOMER][NEUTRAL] Code
[CUSTOMER][NEUTRAL] Uh, when performing.
[AGENT][NEUTRAL] The services are not are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, the doctor's office.
[CUSTOMER][NEUTRAL] Our clinic. OK. Thank you. And actually, I was just making a note, uh.
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, um, uh.
[CUSTOMER][NEUTRAL] Under the member's plan. So, um, and uh, uh, will you tell me the member's plan name?
[AGENT][NEUTRAL] Yes, this is a Medlink.
[AGENT][NEUTRAL] Supplemental insurance policy?
[CUSTOMER][NEUTRAL] Uh, Medilink you said? Medilink.
[AGENT][NEUTRAL] MED
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] L I N K.
[CUSTOMER][NEUTRAL] Mhm. Me link, OK.
[CUSTOMER][NEUTRAL] Supplementary, you said?
[AGENT][NEUTRAL] Yes, supplemental.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] Plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are the other two claims for a different member or they're all for the same member?
[CUSTOMER][NEUTRAL] Yes, yes. uh uh let me check, uh, for the other one.
[CUSTOMER][NEUTRAL] Hm, one moment, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh, for this, for the same member, uh, take the date of service, um,
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, no, I think they both are the same. Just one moment, OK? Um, and, and I just. Actually, the patient has two date of service, but I think the CBT was the same. OK, so just take one more uh date of service that is.
[AGENT][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount is 750.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The same number?
[CUSTOMER][NEUTRAL] Yes, same number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, so we don't have a claim on file with the total bill of $750 for that data service. We do have a claim on file, but
[CUSTOMER][NEUTRAL] Yes, yes. I
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I have to um rebuild the claim, I think uh because um
[CUSTOMER][NEUTRAL] The previous date of service was same, uh, like they, they have the same CPT but um OK, I have to check one moment, OK, uh, [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, so, uh, [PII], uh, let's move to the last claim I have, OK?
[AGENT][NEUTRAL] Is it the same member?
[CUSTOMER][NEUTRAL] Uh, different
[CUSTOMER][NEUTRAL] Different number but under the same facility. Just one moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And and uh call reference number will be the same for both the patients or it will be different?
[AGENT][NEUTRAL] Yes, so the entire call, it'll be my name in today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Just one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 138.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Just one moment and I it's uh uh loading right now, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] Take the member ID 023.
[CUSTOMER][NEUTRAL] 69
[CUSTOMER][NEUTRAL] 772.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the total, I'm sorry, the date of service and total bills?
[CUSTOMER][NEUTRAL] Yes. Um, the date of service will be on [PII] and the bill amount will be.
[CUSTOMER][NEUTRAL] 438-438715.
[AGENT][NEUTRAL] OK, 438. So $4,387.15. OK, here we go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so we do have a claim here for that data service, but it's a different total bill.
[CUSTOMER][NEUTRAL] OK, um, because, um, the remaining balance have are transferred to the secondary, and I think you are the secondary, uh, and right and the primary signal for the patient.
[AGENT][NEUTRAL] OK. Is that what could there be any other balance other than the $4,387.15?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yes, on a CPT 49591.
[CUSTOMER][NEUTRAL] Or just, uh, and do one thing. Just tell me basic claim status uh for the same date of service. I just need the basic claim status, nothing else, OK?
[AGENT][NEUTRAL] OK, I don't think you're understanding me. So, there is a claim here, but it is a different total bill than what you gave. I'm asking if this is the same claim, if there can be another total bill, or if it's only the $4,387.15. If it's only that balance, this is not that claim and I cannot give you the status.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, OK, uh, do one thing.
[AGENT][NEUTRAL] Do you show any other total bill that it can be?
[CUSTOMER][NEUTRAL] Um, OK, and uh, um.
[CUSTOMER][NEUTRAL] Uh, I think, uh, uh, for this claim, I don't have any other questions. Um, OK, [PII], thanks for helping me, OK? I'm done with the claims. Thank you.
[AGENT][POSITIVE] Alrighty.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.