AccountId: 011433970860
ContactId: 4f604ef8-4ecb-4211-bb0b-62547a5728d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248729 ms
Total Talk Time (AGENT): 76345 ms
Total Talk Time (CUSTOMER): 148319 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/4f604ef8-4ecb-4211-bb0b-62547a5728d5_20250217T16:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, hello [PII], this is [PII]. I'm calling on behalf of Mount Sinai Medical Center. I would like to check claim the status for a patient, please.
[AGENT][NEUTRAL] OK, I can verify claim status for you and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] for you and Miss [PII], what is that policy?
[CUSTOMER][NEUTRAL] OK. Policy number, it is
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 61
[CUSTOMER][NEUTRAL] 86
[CUSTOMER][NEUTRAL] 59.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK, thank you. And do you have a callback number in case the call off? Um, yes, it is [PII].
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] And verify the patient's name. Yes, patient's name is um [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you said you're calling for a claim status, correct?
[CUSTOMER][NEUTRAL] OK thank you and you say you're calling.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] OK, and what was the date of service?
[CUSTOMER][NEUTRAL] Yes, date of service was June.
[CUSTOMER][NEUTRAL] Um, actually we have here from [PII].
[CUSTOMER][NEUTRAL] And the total charges for this view were $2,709 with 1 cent.
[AGENT][NEUTRAL] Mm, hold on one moment, Ms. [PII].
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Uh, Mount Sinai Medical Center.
[AGENT][NEUTRAL] OK. And just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] And just to let you know we do have an online service center we providers.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Your a public.
[AGENT][NEUTRAL] And I show the claim processed as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] And I filled the claim process at the outpatient.
[CUSTOMER][NEUTRAL] I'm sorry, so the benefit for this patient has been reached is what you're saying?
[AGENT][POSITIVE] Correct, uh,
[CUSTOMER][POSITIVE] Correct, uh
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you please uh provide me the claim number?
[AGENT][NEUTRAL] Yes, ma'am. 349-056-5.
[CUSTOMER][NEUTRAL] Yes ma'am, 349.
[CUSTOMER][NEUTRAL] OK, so it's 349-056-5.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes. OK, and you said that this claim was denied because um the benefits for this member has been um reached?
[AGENT][POSITIVE] Correct, they have met their outpatient benefit for the year.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so this will be then um patient responsibility?
[AGENT][NEUTRAL] Well, we can't give patient responsibility. We can only verify how we process the claim.
[CUSTOMER][NEGATIVE] Well we can't give patient responsibility.
[CUSTOMER][NEUTRAL] Um, that's OK, thank you for the information and you said your name is [PII] is [PII]
[AGENT][NEUTRAL] Uh [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] Q. Oh thank you. Do you, uh, provide reference number?
[AGENT][NEUTRAL] Uh, no, ma'am. We don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, no, ma'am, we don't give.
[CUSTOMER][POSITIVE] Mhm. OK, thank you so much, [PII]. That's all the information that I needed to know. You have a nice day.
[AGENT][POSITIVE] Uh, yes, ma'am. You too, Ms. [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh yes
[CUSTOMER][NEUTRAL] Bye.