AccountId: 011433970860
ContactId: 728488f0-033a-46bd-92a8-d72ef6e08129
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441940 ms
Total Talk Time (AGENT): 143865 ms
Total Talk Time (CUSTOMER): 157430 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/728488f0-033a-46bd-92a8-d72ef6e08129_20250430T19:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon. My name is [PII] calling from provider's office.
[CUSTOMER][NEUTRAL] And uh I want to know.
[AGENT][NEUTRAL] Um, hi, [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I want to know about the claim status. And before we begin, I would like to let you know that this call is being recorded for quality and training purposes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, I'm calling from Vital MD Group Holding LLC and uh.
[CUSTOMER][NEUTRAL] What else, what other details you need to pull out the claim?
[AGENT][NEUTRAL] I'm sure, sure. I can assist you with claim status. And first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, so I will call back number.
[CUSTOMER][NEUTRAL] A callback number is [PII] and extension is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Please allow me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, policy number is
[CUSTOMER][NEUTRAL] CF, uh, actually.
[CUSTOMER][NEUTRAL] I don't have policy number with me.
[CUSTOMER][NEUTRAL] So, could you just uh
[CUSTOMER][NEUTRAL] Uh, pull out the claim with the patient name and uh.
[CUSTOMER][NEUTRAL] Date of birth?
[AGENT][NEUTRAL] Yes, what's the last name, please?
[CUSTOMER][NEUTRAL] First name is [PII] and last name is [PII] and uh date of birth is uh [PII].
[AGENT][NEUTRAL] Could you please spell the last name?
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first name, please?
[AGENT][POSITIVE] Thank you. And what's the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] And please verify the date of birth.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, no one's coming up under that name and date of birth.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] No one is coming up under that name and date of birth?
[CUSTOMER][NEGATIVE] No, no claim is coming on this game.
[AGENT][NEUTRAL] Right. No member is coming up under that name and date of birth. What's the first name again? I'll try to look again. What's the first name again?
[CUSTOMER][NEUTRAL] And this
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of birth again?
[CUSTOMER][NEUTRAL] Date of service is uh [PII].
[AGENT][NEUTRAL] No date of birth.
[CUSTOMER][NEUTRAL] Date of birth. Date of birth is [PII].
[AGENT][NEUTRAL] The date of, mhm.
[AGENT][NEUTRAL] OK, I found her in our system. And what's the date of service on the claim you're calling about?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the claim amount is $370.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, you said that date of service was [PII] for $370?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Received on [PII].
[AGENT][NEUTRAL] Right, and it also processed on [PII].
[AGENT][NEUTRAL] The claim, the claim number is 357-7703.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 357-7703. The claim number is 3577703.
[AGENT][NEUTRAL] And I'm showing
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So can you please let me know why this claim is denied?
[AGENT][NEUTRAL] And this, this.
[AGENT][NEGATIVE] Yes, this claim denied.
[AGENT][NEUTRAL] Because, um, just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and this policy denied this claim denied because this policy expired on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, that's when the policy expired.
[CUSTOMER][POSITIVE] Thank you so much. May I know the call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII], and today's date. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK. Uh, could you just spell out your name?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And last initial is [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You were very helpful for today.
[AGENT][POSITIVE] Yeah, thank you, [PII], for calling APL. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Have a nice day bye bye.
[CUSTOMER][POSITIVE] No I. Thank you so much.
[AGENT][POSITIVE] OK. I thank you again for calling APO. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.