AccountId: 011433970860
ContactId: e0bedcc9-f592-456e-8af9-dbca3b9bb868
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437850 ms
Total Talk Time (AGENT): 110601 ms
Total Talk Time (CUSTOMER): 152938 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/e0bedcc9-f592-456e-8af9-dbca3b9bb868_20250130T20:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, 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 good. Well, I can help you with the claim status. How are you doing today, sir?
[CUSTOMER][NEUTRAL] Uh, I'm doing fine.
[AGENT][POSITIVE] Awesome, OK, what is your callback number, sir? Just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the, mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Uh, also, uh, take extension, OK, uh, uh [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, OK. Uh, take, uh, take the member ID, uh, uh, OK, uh, 02255.
[CUSTOMER][NEUTRAL] 779. And the patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, let me pull that policy in real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] OK. Uh, the date of service is uh July, uh, OK. [PII] and the bill, bill amount is $400 even.
[AGENT][NEUTRAL] OK, thank you. And then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, OK, one moment, OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] 260.01.
[AGENT][NEUTRAL] OK, thank you and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Vital MD Group holding LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII] while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, OK. Take your time.
[AGENT][POSITIVE] Thank you. Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi [PII], this is [PII] back with you again. I have the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 3037.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, sorry. Uh, could you repeat again? Actually, your voice is breaking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the claim the claim number is 352-303-7.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because this service is not covered when performed in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh hello, hello?
[AGENT][NEUTRAL] Hello, I can hear you.
[CUSTOMER][NEUTRAL] Yes, uh, please, uh, actually, uh, while you're telling the claim number, the, you know, and the, it's taking, um, like it's taking, uh, so you said the claim number is 350 then?
[AGENT][NEUTRAL] No 352-303-7.
[CUSTOMER][NEUTRAL] 3037. OK. 3523037.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, so, uh, a claim, uh, when was the claim received it, uh, and denied it?
[AGENT][NEUTRAL] It was received on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, and, uh,
[CUSTOMER][NEUTRAL] Uh, uh, like, uh, denied as, uh, like, uh, not covered when performing doctor's office.
[AGENT][POSITIVE] Yeah, not, not covered. Yes, that's correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, services are not covered when performed in doctor's office or clinic. Am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And uh what is the plan name of the patient?
[AGENT][NEUTRAL] Medlik.
[CUSTOMER][NEUTRAL] Supplement insurance.
[AGENT][NEUTRAL] Yes, it's a gap insurance.
[CUSTOMER][NEUTRAL] OK. OK. OK. Thank you. Just one moment, OK?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Uh, so, uh, and please don't hang up, uh, uh, provide me the call this number, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so tell me the call reference number.
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] And you can use my name at today's date. Yes.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. So, [PII], OK.
[CUSTOMER][NEUTRAL] So, uh, the, uh, just last time I'm cross-checking, claim number is 3523037, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you, [PII]. Bye.
[AGENT][POSITIVE] You're welcome. You're welcome bye bye you have a great day and thanks for calling APL.