AccountId: 011433970860
ContactId: 5f45c3f5-f127-4fa5-8a68-5ef0b4c882e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 724780 ms
Total Talk Time (AGENT): 230340 ms
Total Talk Time (CUSTOMER): 178203 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/5f45c3f5-f127-4fa5-8a68-5ef0b4c882e2_20250109T20:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, this is [PII]. Uh that is [PII], uh calling from provider's office to check on claims.
[AGENT][NEUTRAL] OK, make sure I can help you with claims. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] I like your name. I have a set of twin grandbabies and their mama's name is [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] She has the same name as you.
[CUSTOMER][NEUTRAL] Oh, but.
[AGENT][NEUTRAL] OK, what is the patient's name?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, yeah, but before we start, I would like to inform you that this call is being recorded for training and quality purpose. So, are you OK with that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, policy ID is 017.
[CUSTOMER][NEUTRAL] 29147
[AGENT][NEUTRAL] OK, and that's 01729147?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the patient's name?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] OK, let me pull this policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. What is the data service for [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That is [PII] $950 even.
[AGENT][NEUTRAL] OK and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] That was, actually, overall bill amount is $950 and the secondary was supposed to be
[CUSTOMER][NEUTRAL] Uh $85.85 dollars.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Uh, that is Vital MD Group Holding.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this, uh, claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Uh, OK, sure.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm 5, yeah 9:50, there we go.
[AGENT][NEUTRAL] 352-382-5
[AGENT][NEUTRAL] 2011045.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. I'm back with you. I do have the claim pulled up.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 382 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We processed the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was paid $25.
[AGENT][NEUTRAL] The check number is 2011045.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm looking to see.
[CUSTOMER][NEUTRAL] Uh, actually, my concern is, uh, primary.
[CUSTOMER][NEUTRAL] Process $85 towards the the co-pay.
[CUSTOMER][NEGATIVE] And we only have received $25.
[AGENT][NEUTRAL] Right, and that is because, right, after we paid the $25 the benefit maximum had been exhausted.
[CUSTOMER][NEUTRAL] Remaining
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, in what, like you need or dollars?
[AGENT][NEUTRAL] I'm sorry, what was the question again?
[CUSTOMER][NEUTRAL] Uh, you said that $25 after paying the $25 the benefit has been exhausted, right?
[AGENT][NEUTRAL] It right.
[CUSTOMER][NEUTRAL] Uh, so my question is in what terms? Like in dollars, in which term benefits? OK.
[AGENT][NEUTRAL] In dollars, yes,
[AGENT][POSITIVE] Yes, in dollars that maxed out the benefit.
[CUSTOMER][NEUTRAL] OK. So may I know the limit? How much you can pay?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Let me look real quick on this.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] On this plan, and this is just to verify coverage, it's not a guarantee of payment. This plan helps with deductible, co-pay, and co-insurance only.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The outpatient benefit amount per occurrence is $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 500, right.
[CUSTOMER][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $475 was paid on another claim for that day.
[AGENT][NEUTRAL] Which, and so the $25 was paid.
[AGENT][NEUTRAL] On this claim which exhausted the $500.
[CUSTOMER][NEUTRAL] OK, so $500 is for year limit, is it year limit or?
[AGENT][NEUTRAL] No, it's per occurrence.
[CUSTOMER][NEUTRAL] Per occurrences.
[CUSTOMER][NEUTRAL] Um, actually, my question is just, there is limit set for like 6 months or a monthly limit or yearly limit, so.
[AGENT][NEUTRAL] No, it's per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm, OK, no issues. Actually, there is one more claim for the same member, just the date of service is different with the same scenario. Can you check that also?
[AGENT][NEUTRAL] OK, what is
[AGENT][NEUTRAL] Yes, I can help you with that. What is the data service for the 2nd 1?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] That is $350. Just a second, let me check that.
[CUSTOMER][NEUTRAL] Yeah, $350.85 dollars was patient responsibility.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I to
[AGENT][NEUTRAL] And it's for the same um facility, is that correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold and I'm gonna look that one up for you. I'll be right back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I have this claim pulled up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352-711-5.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was paid $25.
[AGENT][NEUTRAL] By check, [PII] and it's the same situation after the $25 was paid, it exhausted and maxed out the benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, no issues. Can I have a reference number, please?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] And you can use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, last of the name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. OK, then, thank you so much. Have a great day.
[AGENT][POSITIVE] You too thank you you have a blessed one thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.