AccountId: 011433970860
ContactId: cfcc0c3d-468b-4033-bc51-fd729ab71d3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289399 ms
Total Talk Time (AGENT): 110882 ms
Total Talk Time (CUSTOMER): 86639 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/cfcc0c3d-468b-4033-bc51-fd729ab71d3c_20250130T14:24_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, I'm calling to check status on a claim, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. You're calling from a provider's office.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright and may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name of the, where are you calling from?
[CUSTOMER][NEUTRAL] I'm calling from Vital MD Group Holding LLC.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is 02477075.
[CUSTOMER][NEUTRAL] As soon as possible.
[AGENT][NEUTRAL] OK, bear with me, I'm waiting on my system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And Miss, may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data services [PII] of 24 total charged amount was $75.
[AGENT][NEUTRAL] OK. Alright, let me see if I can find this claim and for future you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like we have processed claim on [PII], I'm sorry, of [PII], and the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me write this.
[CUSTOMER][NEUTRAL] Sorry about the background noise.
[AGENT][POSITIVE] Um, it's OK, no problem.
[CUSTOMER][NEUTRAL] But they so they just.
[CUSTOMER][NEUTRAL] So office visits are not covered.
[AGENT][NEUTRAL] Office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] What is covered?
[AGENT][NEUTRAL] OK, so this one, let's see.
[AGENT][NEUTRAL] OK, so this one has a rider for office treatments or office procedures, but it doesn't cover the office visit co-payment.
[AGENT][NEUTRAL] So it covers outpatient facilities, urgent care, ER.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Surgery centers, or diagnostic centers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And your name again?
[AGENT][NEUTRAL] My name is [PII]'s [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you, so it's, it's safe to say that any services in our office are not gonna be covered.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No, that's not, mm. No. We cover procedures, we cover treatments. We do not cover the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So treatments.
[AGENT][NEUTRAL] And procedures are covered. Office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] And how
[AGENT][NEUTRAL] So they're responsible for the co-payment for the business.
[CUSTOMER][POSITIVE] Sorry about that. OK, perfect, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] That's everything. Have a great day.
[AGENT][POSITIVE] You too. Thank you for calling ATM. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.