AccountId: 011433970860
ContactId: f7612d10-13d7-4418-a3a2-8b6f4f585fe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331200 ms
Total Talk Time (AGENT): 109171 ms
Total Talk Time (CUSTOMER): 88099 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/f7612d10-13d7-4418-a3a2-8b6f4f585fe1_20250522T13:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ETL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so this is [PII] calling from provider's office. Uh, very good morning. I'm looking for the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Vital MD Group holding LLC.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number, it's gonna be 02413429 M as in Mary, I as in igloo 7.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] First name would be the [PII] and the last name would be the [PII].
[AGENT][NEUTRAL] OK, and what's the date of his date of birth?
[CUSTOMER][NEUTRAL] Sure, the member's date of birth, it's gonna be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. The date of service [PII] and the total charge amount $473.25.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim. For future, you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, let me pull this ERP one moment.
[AGENT][NEUTRAL] OK, here it is. OK, looks like we processed the claim on [PII]. We send a benefit amount of $22.06 to the provider.
[CUSTOMER][NEUTRAL] Uh, actually, there is a patient responsibility of the primary $40 copay which is not covered. May I know the reason why it is not covered?
[AGENT][NEUTRAL] Office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Office visits are not covered under member plan, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] You mean the co-pay or co-insurance are not covered under the member's plan?
[AGENT][NEUTRAL] Correct. Any office visits, co-payment or um are not covered or co-insurance are not covered under the member's plan. There's no office visit benefits. Mhm.
[CUSTOMER][NEUTRAL] OK. May I have the member's plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Secondary supplemental plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. May I have your name, please? Could you please spell it for me?
[AGENT][NEUTRAL] Sure. My name is So. That's [PII].
[CUSTOMER][POSITIVE] Thank you so much, sir, and may I have the claim number?
[AGENT][NEUTRAL] OK, let's see one moment. Claim number is 359-5801.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Before the 58, what is the, the 3 consecutive 9 it is?
[AGENT][NEUTRAL] The what I'm sorry?
[CUSTOMER][NEUTRAL] Starting with 3 letters.
[AGENT][NEUTRAL] In 3 letters.
[CUSTOMER][NEUTRAL] Sorry, 3 numbers. uh
[CUSTOMER][NEUTRAL] Could you please provide me once again the claim number?
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] OK. 359-5801.
[CUSTOMER][POSITIVE] 359-5801. Thank you so much, sir and thanks for helping me today. May I have the call number for this?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Sure. Thank you so much, sir, and thanks for helping me today. Have a wonderful day.
[AGENT][POSITIVE] You as well and thank you for calling APL. Have a good day, Mr. [PII].