AccountId: 011433970860
ContactId: 39c08f82-38be-4b21-a0d4-38cf987b2608
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388070 ms
Total Talk Time (AGENT): 127294 ms
Total Talk Time (CUSTOMER): 213139 ms
Interruptions: 13
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/39c08f82-38be-4b21-a0d4-38cf987b2608_20250424T16:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you for calling ATL.
[CUSTOMER][NEUTRAL] Um, hello, [PII], this is [PII]. I'm calling on behalf of Mount Sinai Medical Center to check limit status for one of her patients, please.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] OK, great. I need to check some status for one.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes I
[CUSTOMER][NEUTRAL] your call
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] It's
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] What is the policy.
[CUSTOMER][NEUTRAL] Yes, uh, policy number is.
[CUSTOMER][NEUTRAL] OK. 23691.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], could you please repeat that policy number one more time?
[CUSTOMER][NEUTRAL] OK, could you please repeat that policy?
[CUSTOMER][NEUTRAL] Yes, it's 23691.
[AGENT][NEUTRAL] OK, so that's not enough numbers for a policy number. Do you have the ID card?
[CUSTOMER][NEUTRAL] OK, so that's not enough numbers for a policy number. Do you have an ID card? Um, one moment please, let me check.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do do do do do.
[CUSTOMER][NEUTRAL] That is the group number. Let me pull up the information.
[AGENT][NEUTRAL] Mhm. What is the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, can you please try with this one it's 02.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] 68
[CUSTOMER][NEUTRAL] 05
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, the number 7.
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information [PII] that I did provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] I need the information
[CUSTOMER][NEUTRAL] And not.
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. Last name is [PII], um, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] service
[CUSTOMER][NEUTRAL] Yes, date of service was [PII], and bills amount were $3,912.86.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said the bill amount is $3,912.86?
[CUSTOMER][NEUTRAL] And you said the bill amount is $3,912.80.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I'm seeing here that you guys processed this claim. I have a claim number. I don't know if that will help to find the account. Yes.
[AGENT][NEUTRAL] Is it 346-39007?
[AGENT][POSITIVE] OK, yes ma'am and how can I help you with that claim today?
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[CUSTOMER][NEUTRAL] Um, OK, so I'm seeing here a payment for um 500. Uh, what about the remaining balance?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[AGENT][NEUTRAL] With that payment, the maximum benefit payable for this state of service was met. We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] With that payment, the maximum.
[CUSTOMER][NEUTRAL] We do not determine who responsibility that would be a.
[CUSTOMER][NEUTRAL] OK, so the remaining balance um should be sent to the patient.
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] We do not
[CUSTOMER][NEUTRAL] Mhm mhm. OK. And you said that it that the 500 is the maximum payment allowable.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation, oh, you're welcome. If you need a copy of the explanation of benefits, [PII], you, we do have a portal that you should be able to print that from.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] We do have a portal that you should be able to send that. Mhm.
[AGENT][NEUTRAL] And the website for our portal is [PII].
[CUSTOMER][NEUTRAL] On the website.
[CUSTOMER][POSITIVE] Um, secure.
[AGENT][POSITIVE] With a D on it secured.
[CUSTOMER][NEUTRAL] To be honest. Mhm. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much for the information. Can you repeat one more time your name?
[AGENT][POSITIVE] Yes, ma'am. Well, you're welcome. Absolutely.
[AGENT][NEUTRAL] [PII], and my name along with today's date would be your call reference number if you need one.
[CUSTOMER][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Uh, [PII], and can I have the initial of your last name?
[AGENT][NEUTRAL] [PII], and your initial to your last name?
[CUSTOMER][NEUTRAL] OK. It's [PII]. [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and then gave us.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for the information. Have a nice day.
[AGENT][POSITIVE] Well, I hope you have a nice day too, [PII], if that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Well I hope you have a nice day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mm, bye bye.