AccountId: 011433970860
ContactId: 2c93d5d1-ca90-49c9-952f-37a0b6cf1d1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 874289 ms
Total Talk Time (AGENT): 230268 ms
Total Talk Time (CUSTOMER): 92941 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/2c93d5d1-ca90-49c9-952f-37a0b6cf1d1c_20250527T15:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. This is [PII] calling from Mount Sinai Medical Center. I need to verify if you guys received a claim for a member.
[AGENT][NEUTRAL] Sure I can help you with uh eligibility. Can I get a good call back number and oh, I'm sorry, what?
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] It's claim status.
[AGENT][NEUTRAL] Oh, claim status. OK, I can help you with claim status. Uh, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Claim status.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] That will be.
[CUSTOMER][NEUTRAL] 02503264.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Data service, [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] 7,701 78.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] Right, and do you need the claim number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's 360.
[AGENT][NEUTRAL] 41.
[AGENT][NEUTRAL] 05.
[AGENT][NEUTRAL] It looks like we received that claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And give me just a moment.
[AGENT][NEUTRAL] Sorry my computer is going really slow.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I apologize. My, my computer is just going a little slow while I'm looking that up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I do apologize. I'm just trying to pull up another screen since my last one froze.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what's going on real quick.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] I do apologize for how long that took.
[AGENT][NEUTRAL] It looks like we did receive that claim that that claim was denied and let me see why.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It was a duplicate, so let me find the original.
[AGENT][NEGATIVE] And see why it was denied.
[CUSTOMER][NEUTRAL] No, um, OK, so let me see. Um, [PII], I called, they told me there was no claim on file, so I have faxed the claim with the primary insurance. It will be on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let me see, let me check on something.
[AGENT][NEUTRAL] And because that's the only one I'm seeing for that too.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I don't know why that would be a duplicate either. Here we go, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] OK, for the claim that I saw, it looks like they were trying to, it looks like.
[AGENT][NEGATIVE] It might have been processed wrong where it was billed for the full $7,701 as opposed to the, let me see what it should have been.
[AGENT][NEGATIVE] $1550 because this is a a secondary gap policy. I think it was put in wrong, um.
[AGENT][NEUTRAL] The first time and that's why it showed the second one is a duplicate and so I am showing.
[AGENT][NEUTRAL] That the claim for the $10,000 or I'm sorry, the $1,055 was denied and a letter had been sent to the provider requesting a refund of an overpayment of benefits.
[CUSTOMER][NEGATIVE] Oh no, we never received a a payment from you guys, so.
[AGENT][NEUTRAL] OK, let me see what's going on here, yeah, because it's showing up as 3 different um.
[AGENT][NEUTRAL] Three different things. So let me go into the 3rd 1 and see what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me a moment while I see what's going on here.
[AGENT][NEUTRAL] It looks like it actually has a different claim number.
[AGENT][NEUTRAL] The one that showed that it was paid and I will get to that in a moment um but in case you need that claim number it's 3,601,840.
[AGENT][NEUTRAL] It looks like that was paid, but let me see where it was paid to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like a check was sent out. It is an out, uh, it is an outstanding check. The issue date was [PII]. Can I get you to verify the address that it should have gone to?
[CUSTOMER][NEUTRAL] OK, or PO box. I it was sent to a member or to us?
[AGENT][NEUTRAL] It was sent to, to [PII].
[CUSTOMER][NEUTRAL] If that was sent to us, will be [PII].
[AGENT][NEUTRAL] OK, it looks like it was sent to that address.
[CUSTOMER][NEUTRAL] And how much did you pay?
[AGENT][NEUTRAL] We paid $1,155.40.
[CUSTOMER][NEUTRAL] Paid out
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When it was paid, paid on.
[AGENT][NEUTRAL] It looks like it we issued the check on the [PII].
[CUSTOMER][NEUTRAL] Check number?
[AGENT][NEUTRAL] And it has
[AGENT][NEUTRAL] 204-472-5.
[CUSTOMER][NEUTRAL] Single payment, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect. Thank you very much. Have a wonderful day.
[AGENT][POSITIVE] OK, thank you. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. Thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] OK, you too.