AccountId: 011433970860
ContactId: 60168fd0-5885-4068-b05e-4bcd1403ad93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383320 ms
Total Talk Time (AGENT): 151021 ms
Total Talk Time (CUSTOMER): 174461 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/60168fd0-5885-4068-b05e-4bcd1403ad93_20250527T19:41_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I can hardly hear you. What was your name?
[AGENT][NEUTRAL] OK. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from Mount Sinai Medical Center. I need to get status on several claims for a patient, please.
[AGENT][NEUTRAL] OK, I can help with claim status. [PII], what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] Hold on one second. 01637998 ML the number 8.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] I appreciate that. Thank you. What is the uh date of service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] First date of service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, that is not on file. Uh.
[AGENT][NEUTRAL] Do you, do you know where it might have been sent, [PII], that we, we changed our address around that time. Um, do you know where the, the claim may have been sent or?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, it was just sent, but it's saying here on paper on [PII] of this year. Um, what is the actual address on where it needs to be sent?
[AGENT][NEUTRAL] The um physical address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII]. Our zip code is [PII].
[AGENT][NEUTRAL] [PII]. We also have an online service center if you would be interested or we can fax it as well, whichever you prefer.
[CUSTOMER][NEUTRAL] Hold on one second. You said that was [PII] 248,950 and the zip code is [PII]?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] 8950. OK, it was sent to a different address. Um.
[CUSTOMER][NEUTRAL] Did the patient have active coverage on this data service?
[AGENT][NEUTRAL] Uh, yes, yes, the, the policy, uh, was in effect until [PII]. So yes, it was, it was certainly active during that date.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] If you wanted to reissue, if you wanted to resend that to us.
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Perfect, yes, I will. And is there an does it do the claims have to be sent by by mail or is there an electronic payer number it can be sent to?
[AGENT][NEUTRAL] Our electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] 60. Can you repeat, please?
[AGENT][NEUTRAL] Uh, yes, absolutely. Um 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK, that's the electronic payer number, um, and the ID number I gave you is correct for the patient?
[AGENT][NEUTRAL] Yes, yes, it is.
[CUSTOMER][NEUTRAL] OK, perfect. And you said what was his effective date with the with the policy?
[AGENT][NEUTRAL] From, um, [PII].
[CUSTOMER][POSITIVE] 101 [PII]. OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] All right, um, is there a reference number for the call?
[AGENT][NEUTRAL] Yes, my name is [PII]. We're gonna use that in today's date as our reference.
[AGENT][NEUTRAL] Uh, you said that there were several claims that we could look up. Is there, is there any other dates that we need to.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] No, because I'm, I'm looking down it was sent to the wrong address so I'm, I'm pretty sure the other ones are not on file. They were all sent to the same address.
[AGENT][NEUTRAL] Oh, OK, OK, well, we'll be on the lookout for them and um yeah, is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, let me, let me hold on one second. I think I do have besides the other ones that I was looking for. I have here.
[CUSTOMER][NEUTRAL] Another claim, yes, let me give you this other data service. It looks like we got a denial for this one, same patient, the data service is [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, yes, it's for, um, uh, the, uh, claim number is 35.
[AGENT][NEUTRAL] 08736. Does that sound right?
[CUSTOMER][NEUTRAL] You said, um, I don't have the claim number, so I can't verify. I don't know. This one is for charges of $4,207.50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right, yes, now what we're doing is we see it, it shows on here that the um.
[AGENT][NEUTRAL] that the uh major medical explanation of benefits did not show a deductible co-payment or co-insurance. So let me go ahead and pull this up and see what it says on here, um, because it looks like it's saying.
[CUSTOMER][NEUTRAL] Oh, is that what that denial means? OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it, it, if it, if there's no deductible, co-payment or co-insurance, there's there's really not, nothing that we can pay, so yeah.
[CUSTOMER][NEUTRAL] Exactly, yeah, there's nothing you guys are, are responsible for. I see that now. Yeah, I'm looking at this, yeah. OK, so that's what that denial means. OK. I, I had never seen that before. OK.
[CUSTOMER][POSITIVE] This time as a as a resubmission. OK, that will be all then [PII]. Thank you so much. You have a great afternoon bye bye.
[AGENT][POSITIVE] OK, thank you, thanks for contacting AP have a good.