AccountId: 011433970860
ContactId: 9c553a25-583c-49ed-980c-f7d3da31e655
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420540 ms
Total Talk Time (AGENT): 182625 ms
Total Talk Time (CUSTOMER): 175282 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/9c553a25-583c-49ed-980c-f7d3da31e655_20250328T18:37_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office to check the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you today?
[CUSTOMER][POSITIVE] I'm, I'm also good and it's a weekend, so I'm happy.
[AGENT][NEUTRAL] OK. That's that's right, me too. And do you mind spelling your name for documentation purposes?
[CUSTOMER][NEUTRAL] Yes, yes. Um,
[CUSTOMER][NEUTRAL] My name is [PII], and last name initial is [PII].
[AGENT][POSITIVE] Thank you, [PII], and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Uh, before going ahead, uh, this call is being recorded for quality and training purpose. So the callback number is [PII] and also take extension [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, [PII]. And it would be a pleasure to help you with that claim status today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. It starts with 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 665
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 662
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, patient name is um [PII] and the date of birth is um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And it would be my pleasure to help you with that claim status [PII]. What is the data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, and the date of service uh [PII] and uh bill amount $671 even.
[AGENT][NEUTRAL] All right. Now, if you will bear with me just one moment, let me check that claim status, uh, see if there's another policy. The policy number you gave me turned on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm checking for active coverage for your day. Bear with me just one second.
[CUSTOMER][NEUTRAL] OK. Take your time, [PII].
[AGENT][NEUTRAL] Mhm, thank you, [PII]. I did find an active policy. Can I give you the correct policy information?
[CUSTOMER][NEUTRAL] Yes, [PII], yes.
[AGENT][NEUTRAL] As of [PII], the active policy number for [PII] is 220.
[AGENT][NEUTRAL] 3102 and the policy is current.
[CUSTOMER][NEUTRAL] Uh, OK. So, you, you have to tell me the member ID of the patient?
[AGENT][NEUTRAL] That's correct. And the correct policy number for that um data service and this policy is active as well. And I do have a claim on file for [PII]. What was the bill amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $671 even.
[AGENT][NEUTRAL] And what is the provider name?
[CUSTOMER][NEUTRAL] OK. Um, provider name is Vital MD Group. Uh, I need that ending provide name?
[AGENT][NEUTRAL] I'm, no, just the provider name is fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's Vital MD Group Holding LLC.
[AGENT][POSITIVE] All right, thank you, Royal.
[AGENT][NEUTRAL] Now Royal, we did receive that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim is pending for the primary EOB. We are secondary to the policyholder's major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, [PII], uh, can I send the primary will be via fax? It will be fine?
[AGENT][NEUTRAL] OK. Yes, that would be fine, and you would need to reference the policy number and claim number.
[AGENT][NEUTRAL] And I can give you the claim number.
[CUSTOMER][NEUTRAL] Mhm, uh.
[CUSTOMER][NEUTRAL] OK, um, first, just tell me the current, uh, member ID of the patient. Actually, I did, I didn't make a note of that in the starting, mhm.
[AGENT][NEUTRAL] Sure. Sure, the correct, the correct policy number is 220.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3102
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, this is, this is the current one. This is from uh which active like on which the change, change member ID?
[AGENT][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] The effective number, the effective date on the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm, till now it's active, right?
[AGENT][NEUTRAL] It is still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and, uh, what will be the fax number, uh, [PII], sir?
[AGENT][NEUTRAL] Mhm, fax number to our claims department is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] X number.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Uh, now, uh, tell me the, uh, claim number, [PII].
[AGENT][NEUTRAL] Claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9752.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, OK. Uh, and the call reference number, [PII]?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII] I've already spelled it for you, didn't I? Sorry about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, actually, I, I actually got your name, you know, in the starting, so that's why I didn't ask the like you spell your name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] By the way, um
[CUSTOMER][NEUTRAL] Let me check if I have any more claims of APL or not, OK? Then we will done with this, with this call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I don't see any claim.
[CUSTOMER][NEUTRAL] So, [PII], I don't see any claim of, uh, you know, appeal any more claim. Thank you for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It has been a pleasure to assist you with the claim status. [PII], thank you for calling APL and I hope you have a great weekend as well. Take care.
[CUSTOMER][POSITIVE] Have a great weekend.
[CUSTOMER][NEUTRAL] Yes. Bye.
[AGENT][NEUTRAL] Bye-bye.