AccountId: 011433970860
ContactId: 3c49912a-0c43-470e-af49-a1ccef882597
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628320 ms
Total Talk Time (AGENT): 167320 ms
Total Talk Time (CUSTOMER): 187081 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/3c49912a-0c43-470e-af49-a1ccef882597_20250514T19:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. I'm calling from provider's office to check the claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][NEUTRAL] I am fine.
[AGENT][NEUTRAL] Yeah. And how do you spell your name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you and may I have a callback number just in case we get disconnected, Mr. [PII]
[CUSTOMER][NEUTRAL] Yes, um, before going ahead, this call is being recorded for quality and training purpose. Um, the callback number will be
[CUSTOMER][NEUTRAL] Um, [PII] and uh take extension [PII].
[AGENT][NEUTRAL] OK. And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Vital MD Group Holding LLC.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, it will be.
[CUSTOMER][NEUTRAL] 025578-885.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient, um, date of birth will be.
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the date of service will be, um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, sorry. One moment, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, yes.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] 79 $1,079 even.
[AGENT][NEUTRAL] So the date of service is [PII].
[CUSTOMER][POSITIVE] Mhm. That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, let me see if I can find this claim. One moment.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Do you know what's the procedure code?
[CUSTOMER][NEUTRAL] Yes, there are um three procedure codes bill 76816 and uh 7876816 and uh 76817.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull this information.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I'm still waiting on the EOB. OK, one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Looks like we pay the claim.
[AGENT][NEUTRAL] I'm sorry, it's taking a little bit to pull up.
[CUSTOMER][NEUTRAL] Take your time. Uh, by the way, what's your name? Uh, could you spell your name? I didn't get in the starting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, that's
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, and we processed the claim on [PII]. Again, that was [PII]. We send a benefit amount of $595.30.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just one moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And by the way, um,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, so, uh, you are, uh, you are the secondary insurance for this patient, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, you proceed claim on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And uh also one thing, um,
[CUSTOMER][NEUTRAL] Is there any patient responsibility for procedure code 76816?
[CUSTOMER][NEUTRAL] The primary one.
[AGENT][NEUTRAL] Um, 76816. That one was paid in full. That's $344.43 that went to 76816. Now there is another code for 78616, um, because there are two codes.
[AGENT][NEUTRAL] Of the same.
[CUSTOMER][POSITIVE] Yes, you're correct. You're correct, yes.
[AGENT][NEUTRAL] Um, so the other one, OK, so the, uh, one was paid at 344 43, the other one was paid at $250.87. Um, the reason for that is because with the payment of that check, the maximum has been exhausted.
[CUSTOMER][NEUTRAL] OK. And you said that you have paid uh for the second one, it's 250.87?
[AGENT][NEUTRAL] 200, let me see. Let me go back to $250.87.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. 476-816, right? And uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any patient responsibility, uh, so for the 2nd 1, 76817?
[AGENT][NEUTRAL] 6817. That one was not paid because she already exhausted the benefit. With the 250.87 that we sent, she maxed out her benefits. So anything remaining after that is, is more than likely gonna be patient's responsibility. You will have to go back to the to the member's major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, for the same patient, um, um,
[CUSTOMER][NEUTRAL] Take uh another data service, so, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is
[CUSTOMER][NEUTRAL] Um, $1,342 342 dollars even.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] I don't see a claim for [PII].
[CUSTOMER][NEUTRAL] No, sorry, sorry, [PII], uh, not [PII].
[AGENT][NEUTRAL] [PII]. OK, [PII]. OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let me try another.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I don't see a claim for [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. You didn't find any claim on that date?
[AGENT][NEUTRAL] No, no claim for that day.
[CUSTOMER][NEUTRAL] OK, we have built recently on um [PII], maybe that's fine.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, just one moment. OK. Let me check. I have
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Any more claims of uh American Health or not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK. So, uh, actually, I don't have any more claims of America.
[CUSTOMER][POSITIVE] APL, so thanks for the information and uh
[CUSTOMER][NEUTRAL] Just tell me the call reference number.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name and the state if you will.
[CUSTOMER][POSITIVE] OK. Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling ATL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.