AccountId: 011433970860
ContactId: 56bc5e2b-2175-4ebb-b4cb-5a5794bb8a08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391380 ms
Total Talk Time (AGENT): 160029 ms
Total Talk Time (CUSTOMER): 131032 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/56bc5e2b-2175-4ebb-b4cb-5a5794bb8a08_20250217T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office checking on claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, sorry about that, and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], sorry, it's [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah. It's 02003072.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII], what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. total bill amount $900 even.
[AGENT][NEUTRAL] OK, alright, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Was this through a vital MD group?
[CUSTOMER][NEUTRAL] Yeah, Vital MD Group holding LLC.
[AGENT][NEUTRAL] Got it. OK, so we did receive this claim, [PII], uh, looks like we're missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the fax number, claim number, and call reference number?
[AGENT][NEUTRAL] Sure, so the claim number is 3546979.
[CUSTOMER][NEUTRAL] It's 354-6979. Is that correct?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Correct, and then I've got that fax number whenever whenever you're ready.
[CUSTOMER][POSITIVE] Yeah, yeah, I'm ready.
[AGENT][NEUTRAL] It, it is [PII].
[CUSTOMER][NEUTRAL] Ma'am, actually your voice is not coming properly. Can you please repeat it again?
[AGENT][NEUTRAL] Oh sorry about that um so it is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, got it. Uh, and call reference and spell your name for me, and I do have one more claim after this one.
[AGENT][NEUTRAL] Sure, so the reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][POSITIVE] Thank you for that 1 may I proceed further with the next claim actually.
[AGENT][NEUTRAL] Uh, one moment, I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Was this for a different member right?
[CUSTOMER][NEUTRAL] Yeah, same provider different member.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah, policy number is 02450260.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then what was the date of service for this client?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, it's [PII]. Total bill amount is $850 even.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, let's see, so we did receive this claim, uh, we were unable to pay a benefit, uh, this policy provides no benefits for treatments of conditions other than a sickness or an injury.
[CUSTOMER][NEUTRAL] Uh, so it's not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Policy as per member's plan or for this contract?
[AGENT][NEUTRAL] For this patient's plan.
[CUSTOMER][NEUTRAL] OK, as per.
[CUSTOMER][NEUTRAL] Can you please provide me the plan name?
[AGENT][NEUTRAL] Yes, so this is a secondary medical policy that is supplemental. Uh, the name is Medlink, so M E D L I N K.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Meddling or secondary supplementary gap policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the effective and term date?
[AGENT][NEUTRAL] Yes, so this policy's effective date was [PII].
[AGENT][NEUTRAL] And it did terminate [PII].
[CUSTOMER][NEUTRAL] And for your current information, this call may be recorded for training and quality purposes. Can you please provide me the claim number?
[AGENT][NEUTRAL] Yes, that is 356-044-3.
[CUSTOMER][NEUTRAL] Ma'am, actually, this is an uh
[CUSTOMER][NEUTRAL] The CPT code is and surgery code, it's 54,150, so it will not pay.
[AGENT][NEUTRAL] Hold on 54,150 correct.
[CUSTOMER][NEGATIVE] Uh this is also in sickness.
[AGENT][NEUTRAL] Uh, if you'd like, [PII], I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] So it should be paid, right?
[CUSTOMER][NEUTRAL] OK, no problem. Uh, can you uh call reference should be same, right?
[AGENT][NEUTRAL] Reference number would be the same, yes.
[CUSTOMER][NEUTRAL] Yeah, and just verify the fax number. It's [PII]. Is that correct?
[AGENT][NEUTRAL] That's correct, yes. Did you want me to send you a copy of this EOB?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back, make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yeah, last is [PII].
[AGENT][NEUTRAL] Got it. OK, yes, and I would just put this to your attention.
[CUSTOMER][NEUTRAL] Yeah, attention to claims department, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much for that information and have a great day. Bye for now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Who is that?
[CUSTOMER][NEUTRAL] Yeah