AccountId: 011433970860
ContactId: 74350314-3a4a-45af-9d7a-236315faa769
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344540 ms
Total Talk Time (AGENT): 107582 ms
Total Talk Time (CUSTOMER): 96872 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/74350314-3a4a-45af-9d7a-236315faa769_20250522T18:21_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from provider's office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And checking on claims and this call is being recorded for training and quality purposes. Is that OK for you?
[AGENT][NEUTRAL] Sure, I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Vital MD Group Holding LLC and can you please spell out your name for me?
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII]. That's initial [PII].
[AGENT][NEUTRAL] And may I have the patient's policy number? OK.
[CUSTOMER][POSITIVE] Thank you so much, Sol. I'm actually, yes, yes, uh, patient's policy ID is 02419374 M as in Mike, L as in Lima number 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name, first name is [PII]. Last name is [PII]. Date of birth is uh [PII].
[AGENT][NEUTRAL] OK, thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, date of service is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII] and the total charge is $500 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, for future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we have processed this several times. They're both doing the same. Let me pull this last one.
[AGENT][NEUTRAL] OK, so the last submission we received [PII], process [PII].
[AGENT][NEUTRAL] Of [PII]. And the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Office visits are not covered by the policy. So, uh, actually, uh,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Actually, previously we have submitted an appeal also with the primary OB because claim was denied for primary OB I guess.
[AGENT][NEUTRAL] Um, we have not received that, um, submission. The last submission we received was this one, which it was a regular claim and it was denied with the same reason that the previous one denied, which is office visits are not covered by the policy. We're not requesting the primary EOB.
[CUSTOMER][NEUTRAL] OK. OK can you please hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, just a second.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So you have never requested primary OB, right?
[AGENT][NEUTRAL] No, we have not. It's always been the nice stating that office visits are not covered.
[CUSTOMER][NEUTRAL] And this claim is processed as secondary, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the, uh, claim number?
[AGENT][NEUTRAL] Um, yes, the claim number is 357-8458.
[CUSTOMER][NEUTRAL] 357-845-8, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And what will be the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in the state if you will.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. OK, [PII]. Thank you so much. Have a great day. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APL bye-bye.
[CUSTOMER][NEUTRAL] Mhm.