AccountId: 011433970860
ContactId: 1d6c690f-bf38-4579-a4b2-206d01f69332
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382899 ms
Total Talk Time (AGENT): 174818 ms
Total Talk Time (CUSTOMER): 271731 ms
Interruptions: 25
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/1d6c690f-bf38-4579-a4b2-206d01f69332_20250313T19:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello, this is [PII]. I'm calling on behalf of Mount Sinai Medical Center. I would like to get claiming status for one of our patients, please.
[AGENT][NEUTRAL] Sure, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] For you, uh,
[CUSTOMER][NEUTRAL] Um, yes, callback number it is [PII].
[CUSTOMER][NEUTRAL] Um, I'm sorry, I didn't, I didn't get your name. What is your name?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That's OK, it's [PII]
[CUSTOMER][POSITIVE] That's OK, it's [PII] Thank you, [PII].
[AGENT][NEUTRAL] Of course. And then can I get that policy number, please?
[CUSTOMER][NEUTRAL] And I can
[CUSTOMER][NEUTRAL] Yes, policy number is 1278332.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] And then uh what was the name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK perfect thank you for verifying that [PII]. What was the date of service for this claim?
[CUSTOMER][POSITIVE] OK perfect thank you for
[CUSTOMER][NEUTRAL] What was the date?
[CUSTOMER][NEUTRAL] Um, yes, date of service was [PII] and the amount was $143.
[AGENT][NEUTRAL] OK, so give me just a moment. This policy actually terminated [PII]. Uh, let me see if he had one or she had one active at that time. Give me just a moment.
[CUSTOMER][NEUTRAL] OK, so give me just a moment. This policy actually terminated [PII].
[CUSTOMER][NEUTRAL] Mhm uh let me see if she had one or she had one accident.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so it looks like she actually had a couple of policies with us. She did have a limited indemnity medical plan and a secondary medical policy. Um, the secondary medical terminated.
[CUSTOMER][NEUTRAL] OK, so looks like she actually had a.
[CUSTOMER][NEUTRAL] she did have a limited in.
[CUSTOMER][NEUTRAL] And a secondary medical.
[CUSTOMER][NEUTRAL] Um, the secondary medical terminated.
[AGENT][NEUTRAL] In [PII], so I can still check to see if we received them for either one if you'd like.
[CUSTOMER][NEUTRAL] So I can still check to see if you received them for year one if you like. Um, yes please.
[AGENT][NEUTRAL] OK, sure, give me just a moment and again just to confirm that was [PII]?
[CUSTOMER][NEUTRAL] OK, sure, give me just a moment. Mhm take your time that was [PII].
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Um, yes, [PII].
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][POSITIVE] Got it OK thank you one moment. OK, it's OK, take your time.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] OK, so yes, we did receive it um under the different policy uh it was their secondary medical so it is a different policy number, but we did receive it um and of course unable to pay benefits as the services were rendered after coverage was terminated. If you'd like, I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Um, under the different policy, uh, it was a secondary medical.
[CUSTOMER][NEGATIVE] Number, but we did receive it um and of course unable to pay benefits as the services.
[CUSTOMER][NEUTRAL] If you'd like I can send you a copy of the COV. Um, yes, please, that would be great. So you mean that um this um payer is this patient's secondary insurance?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, so they did have both, um, this was their secondary medical and it did terminate [PII].
[CUSTOMER][NEUTRAL] Yes, so they did have both, um, this was their secondary medical and it did terminate [PII].
[CUSTOMER][NEUTRAL] [PII], so that means this patient was not effective for this date of service.
[AGENT][NEUTRAL] Correct, yes, they had no active coverage with us at that date of service.
[CUSTOMER][NEUTRAL] Correct, yes, they had no active coverage with us.
[CUSTOMER][NEUTRAL] Um, OK, um, and you have denied this claim because of that reason?
[AGENT][NEUTRAL] Yes, as they their coverage was terminated before the state of service.
[CUSTOMER][NEUTRAL] Yes, as they their coverage was terminated before the state. Can I have the effective date?
[AGENT][NEUTRAL] Sure, this policy's effective date was [PII], but again this is a different policy number than the one that you gave me. Did you want me to give you this one?
[CUSTOMER][NEUTRAL] Sure, this policy's effective date was [PII], but again this is a different policy number than the one you gave. you want me to give you this one.
[CUSTOMER][NEUTRAL] Um, yes, I need the, uh, effective date for the policy number that I provide you.
[AGENT][NEUTRAL] Oh, OK, now that's not where this policy this uh claim went just so that you're aware.
[CUSTOMER][NEUTRAL] Oh, OK. Now that's not where this call this, uh, claim went just so that you're aware.
[CUSTOMER][NEUTRAL] Uh, what do you mean?
[AGENT][NEUTRAL] The claim was filed under a different policy number, so the policy number you gave me, that's not where the claim was located under.
[CUSTOMER][NEUTRAL] The claim was filed under a different policy.
[CUSTOMER][NEUTRAL] So the policy number you gave me, that's not where the claim.
[CUSTOMER][NEUTRAL] And what is the policy number that you have?
[AGENT][NEUTRAL] Yes, that is 01137888.
[CUSTOMER][NEUTRAL] Yes, that is 0113.
[CUSTOMER][NEUTRAL] 7888.
[CUSTOMER][NEUTRAL] And this claim was filed under that policy number?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct. OK.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Sure, sorry, I know it's very confusing.
[CUSTOMER][NEUTRAL] Sure, sorry, I know it's very confusing. Yes. OK, so, um, this name was filed under this policy number 01137888. And this uh policy was effective from [PII], correct?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That is, that is correct, yes.
[CUSTOMER][NEUTRAL] That is correct. OK, thank you, got it. Um, can you please send me a copy for this EOB?
[AGENT][POSITIVE] You are welcome.
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] Of course
[CUSTOMER][NEUTRAL] Yes, fax number will be, 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, fax number is 678.
[CUSTOMER][NEUTRAL] 580
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] 57.
[AGENT][NEUTRAL] OK, I'm going to read that back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 580.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, I will get that sent to you. Go ahead I'm sorry.
[CUSTOMER][NEUTRAL] OK and I will get that.
[CUSTOMER][NEUTRAL] Uh, [PII], one more thing, can you please attach my name on this EOV?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, is it uh [PII]?
[CUSTOMER][NEUTRAL] Yes, is it uh [PII]? Yes, that is correct. You got it. Can I have the claim number just for my notes?
[AGENT][POSITIVE] Awesome, OK.
[AGENT][NEUTRAL] Yes, of course. Let me get that. That is 3482656.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] that that is 3482.
[CUSTOMER][NEUTRAL] 65
[CUSTOMER][POSITIVE] 56 OK thank you.
[AGENT][POSITIVE] You are welcome. Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] You are welcome. Was there anything else I can help? Um, no, that will be all. Thank you so much for your help, [PII]. um, you have a nice day.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You too thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] You too thanks for calling ATL. bye bye.