AccountId: 011433970860
ContactId: 3a5ac5b5-bff8-4d9c-b8e1-69c851cef52c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361239 ms
Total Talk Time (AGENT): 143501 ms
Total Talk Time (CUSTOMER): 202178 ms
Interruptions: 15
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/3a5ac5b5-bff8-4d9c-b8e1-69c851cef52c_20250429T12:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you for calling A. This is. How can I.
[CUSTOMER][NEUTRAL] Um, hello [PII], this is [PII]. I'm calling on behalf of Mount Sinai Medical Center, um, to check the status for one of our patients, please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and you did say your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] OK, and you did say your name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, ma'am. And you have one patient you're needing claim status for, is that also correct?
[CUSTOMER][POSITIVE] OK thank you you have one.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] What is the member's policy?
[CUSTOMER][NEUTRAL] Um, yes, member policy number it's 02.
[CUSTOMER][NEUTRAL] 1350.
[CUSTOMER][NEUTRAL] 07
[CUSTOMER][NEUTRAL] M as in mom, L as in Lima, the number 8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And any information that I provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Give me the information that I provide for you today will be a verification.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. Last name is [PII], is spelled [PII] Um date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] And what is the date of
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yes, date of service was [PII] and bill amount was um $18,230 with 19 cents.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that this claim, [PII] has received back on [PII].
[CUSTOMER][NEUTRAL] Received back on [PII].
[AGENT][NEUTRAL] Of 24 and it was processed on 81.
[CUSTOMER][NEUTRAL] 24 and it was processed on 81.
[AGENT][NEUTRAL] The claim number is 348.
[CUSTOMER][NEUTRAL] Mhm. The phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the reason for the denial states.
[CUSTOMER][NEUTRAL] And the reason for the denial.
[AGENT][NEUTRAL] Benefits are payable only if your major medical insurance provider provides benefits.
[CUSTOMER][NEUTRAL] Benefits payable.
[CUSTOMER][NEUTRAL] Only if you
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] If this claim is later paid.
[CUSTOMER][NEUTRAL] Uh, I'm sorry.
[CUSTOMER][NEUTRAL] Um, benefits are payable on this?
[AGENT][NEUTRAL] Only
[CUSTOMER][NEUTRAL] Only
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Your major medical insurance.
[CUSTOMER][NEUTRAL] Your
[AGENT][NEUTRAL] Provider
[CUSTOMER][NEUTRAL] Providers
[AGENT][POSITIVE] Provides benefits.
[CUSTOMER][NEUTRAL] Provides
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance,
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I later paid by your.
[AGENT][NEUTRAL] Please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please send the explanation.
[CUSTOMER][NEUTRAL] Showing
[CUSTOMER][NEUTRAL] OK, so, uh, do we need to send the primary explanation of benefit, right?
[AGENT][NEUTRAL] Yes, ma'am. If they, if it's showing the benefits were paid for that amount for that data service, yes, ma'am.
[CUSTOMER][NEUTRAL] Yes if they showing the benefits will pay for that.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Um, let me check the information because yes we have here that this claim was processed previously by the primary insurance. So if you need the um primary EOB we need, we can send that information. Uh, what is your timing filing by the way?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] There would not be a timely filing for this. You would just need to send the primary EOB.
[CUSTOMER][NEUTRAL] There would not be a time on she would just.
[CUSTOMER][POSITIVE] OK thank you um.
[AGENT][POSITIVE] Yes ma'am, you're welcome.
[CUSTOMER][NEUTRAL] Can I have a reference number, [PII]?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] You need to be climbing along to the state.
[AGENT][NEUTRAL] And [PII], if you don't already have this information, we do have a portal that you should be able to print this explanation of benefits from with that remark on it.
[CUSTOMER][NEUTRAL] And [PII], if you don't already have this information, we do have a portal that you should be able to print with this information.
[CUSTOMER][NEUTRAL] It um with that remark on.
[AGENT][NEUTRAL] Now that you have the claim number by going to secured.
[CUSTOMER][NEUTRAL] Now that you have my number I go to the keyword.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A and.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] for the information. Have a nice day.
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am. You too. Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Um, yes, return.
[CUSTOMER][POSITIVE] Um, that will, that will be all. Thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. And again, thank you for calling and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] OK, you're very welcome.
[CUSTOMER][POSITIVE] I hope you have a wonderful day. Bye.
[AGENT][NEUTRAL] Bye-bye.