AccountId: 011433970860
ContactId: 8cdb19af-5322-4bdb-b6ba-535ba90ad922
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245910 ms
Total Talk Time (AGENT): 94030 ms
Total Talk Time (CUSTOMER): 67967 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/8cdb19af-5322-4bdb-b6ba-535ba90ad922_20250312T14:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office. I'm checking for the claim status and this call is getting recorded for the quality and training purpose. And, and uh, can you please spell out your name for my documentation purpose?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. And did you say your name was [PII]?
[CUSTOMER][NEUTRAL] It's Via, Victor, [PII] Delta Yankee Alpha [PII].
[AGENT][POSITIVE] Thank you. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, just one.
[AGENT][NEUTRAL] All right, may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 01988939.
[AGENT][NEUTRAL] All right, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] The date of service is [PII] for the bill amount of $397 even.
[AGENT][NEUTRAL] [PII] $397.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, that is Vital MD Group holding LLC.
[AGENT][NEUTRAL] Here we go. Hold on one moment.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 356-0993.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] Because the service was performed, it it wasn't a covered place of service.
[CUSTOMER][NEUTRAL] Which place of services does not cover?
[AGENT][NEUTRAL] OK, so the codes that were used 1,117,110 and 81002, if it's performed in a doctor's office or clinic, it's not covered by the policy.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Is there any other insurance for this member?
[AGENT][NEUTRAL] Yes, their primary insurance.
[AGENT][NEUTRAL] Um, which we're showing as Florida Blue.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, apart from that, is there any other?
[AGENT][NEUTRAL] Not that we know of. We're only 2nd to Florida Blue.
[CUSTOMER][NEUTRAL] OK. Can I have the call reference number for today's conversation?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII], for assisting me today. Bye for now and have a nice day.
[AGENT][POSITIVE] You're welcomey. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Wish you the same. Bye for now.
[AGENT][POSITIVE] Thank you. Bye-bye.