AccountId: 011433970860
ContactId: 47dfb30d-af82-4290-94f1-4e005793f071
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314920 ms
Total Talk Time (AGENT): 102485 ms
Total Talk Time (CUSTOMER): 174452 ms
Interruptions: 10
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/47dfb30d-af82-4290-94f1-4e005793f071_20250124T17:57_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Afternoon. Thank you for calling AL.
[CUSTOMER][NEUTRAL] Um, hello, this is [PII]. The initial of my last name is [PII]. I'm calling on behalf of Mount Sinai Medical Center. I would like to check, uh, members eligibility and also to know um if you have received a claim from us.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility and claim status, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, yes, absolutely. It is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][POSITIVE] Thank you and may I have the call.
[CUSTOMER][NEUTRAL] Yes, uh, member's policy number.
[CUSTOMER][NEUTRAL] It is 02.
[CUSTOMER][NEUTRAL] 03
[CUSTOMER][NEUTRAL] 75
[CUSTOMER][NEUTRAL] 88.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. All right, and you say you need eligibility. We have an effective date of [PII] and it terminated [PII]. Um, what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] we have an effective date of [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Um, what is the?
[CUSTOMER][NEUTRAL] I'm sorry, you said that member started to be eligible in [PII] and the policy ended on May, I'm sorry, on [PII]?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Yes, that is correct. OK, thank you. Yes, I'm reviewing here that this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim is for the date of service.
[CUSTOMER][NEUTRAL] [PII]. So, yes, member, was.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I can do. I'm gonna check and see if we got it.
[CUSTOMER][NEUTRAL] Um, do you want me to check and see if we got it.
[CUSTOMER][NEUTRAL] Yes, I can see here that this claim, um, I mean checking our system, I can see that this claim was already submitted to you guys. Can you please um let me know if you have received it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check for you, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And what is the procedure code?
[CUSTOMER][NEUTRAL] What is the procedure
[CUSTOMER][NEUTRAL] Procedure code, let me check one second.
[CUSTOMER][NEUTRAL] It's 93,000.
[CUSTOMER][NEUTRAL] It's a routine electrocardiogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the charges deals were for $66 even.
[AGENT][NEUTRAL] OK. All right, I see it here. One moment. It looks like that claim was denied. Let me pull the EOB one moment.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm waiting on the ERP.
[AGENT][NEUTRAL] OK, so we processed the claim on [PII].
[CUSTOMER][NEUTRAL] the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied, um, the denial reason is that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] And the claim was denied, um, the denial reason is that the service.
[CUSTOMER][NEUTRAL] I'm sorry, the service?
[AGENT][NEUTRAL] Service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] Service is not covered when performed in the doctor.
[CUSTOMER][POSITIVE] Uh, thank you so much for the information. Can you please provide me the claim number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure, the claim number is 352.
[CUSTOMER][NEUTRAL] Sure, the claim number is 352-771-0.
[AGENT][NEUTRAL] 7710.
[CUSTOMER][NEUTRAL] 352-771-0
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] Service not cover the phones. OK, thank you. um, can you please um provide me your name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. Thank you. So, is there any reference number that you can provide me or can I just your name as a reference? You don't have reference.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name today.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so that's all the information that I needed to know you have a nice day thank you.
[AGENT][POSITIVE] You're welcome, Ms. [PII] as well, and thank you for calling APO.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.