AccountId: 011433970860
ContactId: 2a484fc9-5d7e-43c0-9820-b0a575950f5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344160 ms
Total Talk Time (AGENT): 154305 ms
Total Talk Time (CUSTOMER): 97072 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/2a484fc9-5d7e-43c0-9820-b0a575950f5b_20250206T16:57_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh hi, this is [PII] calling from provider's office to check on claims.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. And how do you spell your name?
[CUSTOMER][NEUTRAL] I've
[CUSTOMER][NEUTRAL] Uh, [PII]. Uh, can you spell yours too?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, but before we proceed, I would like to inform you this call is being recorded for training and quality purpose. So, are you OK with it?
[AGENT][NEUTRAL] Yeah, sure. Yes.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, policy number is 02450260.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and Miss, where are you calling from, from my notations?
[CUSTOMER][NEUTRAL] Uh, from [PII] facility name is Vital MD Group Holding.
[AGENT][NEUTRAL] I don't. OK, thank you. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] That is [PII], [PII].
[AGENT][NEUTRAL] Mm perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] amount is $518 even.
[AGENT][NEUTRAL] OK. [PII] for 5:18. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and let me see if this claim, let me pull this one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, OK, yeah, this is it. Alright, it looks like we processed this claim on [PII] and we send a benefit amount of $25 to the provider.
[AGENT][NEUTRAL] And let me see what we only send 25 with the payment of the check, the maximum for the benefit has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So $30 has been denied for the maximum benefit.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Uh, may I know what is the limit for the day or what?
[AGENT][NEUTRAL] $25 is the maximum up to 4 visits per year.
[CUSTOMER][NEUTRAL] All $25 allowed per day.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] To 4 days per year. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I have claim number?
[AGENT][NEUTRAL] Um, sure. The claim number is 3543629.
[CUSTOMER][NEUTRAL] OK. I do have one more data service for the same patient.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] $400 even.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] OK, thank you. Let me see if I can find that one.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] This is for procedure code 76816.
[CUSTOMER][NEUTRAL] Oh yes, right.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so the last time we processed the claim was on [PII], and we send a benefit amount of $25 which is the maximum per date of service.
[CUSTOMER][NEUTRAL] Oh, same as previous, only $25 is allowed per visit or per day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK. And what's the claim number for that?
[AGENT][NEUTRAL] OK, for this one, it is 3543425.
[CUSTOMER][NEUTRAL] OK, and what will be the caller reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][POSITIVE] OK. OK, then. Thank you so much. Have a great day.
[AGENT][POSITIVE] You as well. Thank you for calling APL. bye bye.
[CUSTOMER][NEUTRAL] Goodbye.
[AGENT][NEUTRAL] Bye bye.