AccountId: 011433970860
ContactId: b30a724b-150a-44ea-8629-2da6023035a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283359 ms
Total Talk Time (AGENT): 77617 ms
Total Talk Time (CUSTOMER): 96777 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/b30a724b-150a-44ea-8629-2da6023035a9_20250515T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling from Vital MD.
[AGENT][POSITIVE] How can I help today?
[CUSTOMER][NEUTRAL] Uh, I just want to know the claim status.
[AGENT][NEUTRAL] OK, happy to check on a claim. What's the patient policy number?
[CUSTOMER][NEUTRAL] Uh yes, the policy number is 01659528ML8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] May I have patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $370 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEGATIVE] Alright, so it looks like we did receive a claim for this state of service. It was received on [PII] or [PII], excuse me, [PII]. The claim was denied. Of office visits are not covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But, uh, uh, previously it was paid for this CPT.
[AGENT][NEUTRAL] Do you have that claim number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, claim claim number? I don't have claim number.
[AGENT][NEUTRAL] Well, I'm, yeah, I'm showing that the office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Uh, but, uh, as I can see in my system that previously for the CPT only that, uh, the insurance has paid.
[AGENT][NEUTRAL] Your
[CUSTOMER][NEUTRAL] So, can you please, uh,
[AGENT][NEUTRAL] You can appeal the decision if you would like.
[CUSTOMER][NEUTRAL] OK. Just wait, hold on a sec.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for waiting. So, um, that you said.
[CUSTOMER][NEUTRAL] Send an appeal. So, with the medical records?
[CUSTOMER][NEUTRAL] say.
[AGENT][NEUTRAL] Yeah, if you, if they would like to submit an appeal that can be done within 180 days of the decision.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, yeah, but with the medical records, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you provide me the claim number and call reference number?
[AGENT][NEUTRAL] Claim number is 3592425.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], that's [PII] The last initial, my name is [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Have a great day too.