AccountId: 011433970860
ContactId: 6cae1655-c35c-407a-82a1-6c633d99f8b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530659 ms
Total Talk Time (AGENT): 111277 ms
Total Talk Time (CUSTOMER): 101450 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/6cae1655-c35c-407a-82a1-6c633d99f8b7_20250206T16:00_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] Uh, hi, my name is [PII] calling from provider office check on service.
[AGENT][POSITIVE] Sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yes, and before proceeding further, please note this call is getting recorded for quality and training purpose. So are you OK with it?
[AGENT][NEUTRAL] Mm, sure, yes. Mhm.
[CUSTOMER][NEUTRAL] Uh yes, the callback number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, and thank you. And you're calling from?
[CUSTOMER][NEUTRAL] Oh, Vital MD Group Holding LLC.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] OK, thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes, the patient policy number is 024.
[CUSTOMER][NEUTRAL] 73
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] 1 M as in Mike, L as in Lima, then 8.
[AGENT][POSITIVE] Um, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh yes. The patient name is [PII]. And the last name, let me spell out for you, that is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and let's see, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill was the amount for 4000 $4100 even.
[AGENT][NEUTRAL] All right, thank you. Let me see if I can find this claim for you. And for the future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Wait one moment.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's for procedure code 58558.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment, let me pull the EB.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, it looks like we processed this claim on [PII] and the claim was denied. Um, the reason for this denial is, let's see.
[AGENT][NEUTRAL] Looks like the maximum benefit for the date of service has been met.
[CUSTOMER][NEUTRAL] OK, so you do not have the max benefit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, OK. And can you just tell me when the previously it has been made?
[AGENT][NEUTRAL] We can release that information because it doesn't pertain to your claim.
[AGENT][NEUTRAL] Do you need the claim number for your claim?
[CUSTOMER][NEUTRAL] Uh yes, claim number. Uh, you don't have any information about that?
[AGENT][NEUTRAL] OK, the
[AGENT][NEUTRAL] We cannot release that information. It doesn't pertain to your claim, Mr. [PII]. We can only give you information about your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, I just want to know when the, this, the date of service when has been previously made.
[AGENT][NEUTRAL] We cannot
[AGENT][NEUTRAL] We cannot release that information, Mr. [PII]. We cannot release information about a third party or somebody else's. I can only give you information about your claim.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, uh, so can you please provide me the claim number?
[AGENT][NEUTRAL] Sure, your claim number is 353-599-6.
[CUSTOMER][NEUTRAL] 96. OK. And can you please spell out your name for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] OK, and the call reference for today's call?
[AGENT][NEUTRAL] My name in today's name.
[CUSTOMER][POSITIVE] So OK. So thank you for your assistance and have a wonderful day.
[AGENT][POSITIVE] You as well, Mr. [PII] and thank you for calling APM. Bye-bye.
[CUSTOMER][NEGATIVE] You are on hold.