AccountId: 011433970860
ContactId: 25e22b77-fe08-4170-9581-81e9804abc20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461760 ms
Total Talk Time (AGENT): 114114 ms
Total Talk Time (CUSTOMER): 153412 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/25e22b77-fe08-4170-9581-81e9804abc20_20250522T20:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from the provider office to have uh to check the claim status and this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yes [PII], and what is your callback number just in case the call is disconnected and I can help you with claim status.
[CUSTOMER][NEUTRAL] OK, so the callback number is [PII] and then extension is [PII].
[CUSTOMER][NEUTRAL] And can you please help me with your name too, because I did miss to write down your name.
[AGENT][NEUTRAL] OK. Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] And last name initial is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, OK, so yes, go ahead with the verification process. What detail you needed.
[AGENT][NEUTRAL] OK, um, I'll need to get the member's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] Definitely give me a second. So the member's name is, so the, I'm starting with the policy number which is 02039877 M as in Mike, L as in Lima 8 and then his name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] OK, let me pull up his policy real quick.
[AGENT][NEUTRAL] OK, I do show, uh,
[AGENT][NEUTRAL] [PII], and what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the rate of service I'm looking for is [PII] with the total bill amount of $689 even.
[AGENT][NEUTRAL] OK, let me pull up that real quick.
[AGENT][NEUTRAL] And then um what is the um charges after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEGATIVE] Also, the charges we have billed after the primary insurance pay this part was $40 even.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] It is uh Vital MD Group holding LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I'll be right back.
[CUSTOMER][POSITIVE] OK, take your time, dear.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh shoot.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thank you, [PII] for holding for me. I've got the claim information for you.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Uh, the claim number is 3593568.
[AGENT][NEUTRAL] And the claim has been denied.
[CUSTOMER][NEUTRAL] 356 8
[AGENT][NEUTRAL] Yeah, 359-356-8.
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][NEUTRAL] OK. Can you please help me when did this claim was received?
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEGATIVE] That means denied.
[AGENT][NEUTRAL] Yes, we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, give me a second here. Let me make a note for this one. And can you, uh, help me, can you please help me? claim is denied for primary EOB and I need your fax number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] GOB, yeah.
[CUSTOMER][NEUTRAL] I need your fax number.
[AGENT][NEUTRAL] OK, it's
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], right? I'm repeating it again. It is [PII]. Is it correct?
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And anything else I needed to take.
[CUSTOMER][NEUTRAL] No, uh, that's all I needed. Thank you for helping me with this. Uh, can you please help me with the call reference number, whatever you guys have?
[AGENT][NEUTRAL] Yes, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] I'm sorry, thank you for helping me, but uh again, I'm just want to confirm the claim number is 3593568, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. So yeah, thank you for helping me with this claim. That means a lot for me. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] You have a good day too, Ms. [PII], and thank you for calling APL. Bye-bye, ma'am.
[CUSTOMER][POSITIVE] Thank you bye