AccountId: 011433970860
ContactId: 66cf2f03-e614-4f1b-ad70-4f528d6760dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417559 ms
Total Talk Time (AGENT): 86019 ms
Total Talk Time (CUSTOMER): 196309 ms
Interruptions: 10
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/66cf2f03-e614-4f1b-ad70-4f528d6760dc_20250507T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] W. How may I help you?
[CUSTOMER][NEUTRAL] Um, hello. Good morning, [PII]. This is [PII]. Is it spelled [PII] Um, the initial of my last name is [PII]. I'm calling on behalf of Mount Sinai Medical Center um to check claim the status for one of our patients, please.
[AGENT][NEUTRAL] OK, I can help you with claim status. Ms. [PII], can I please get your callback number just in case the call is dropped?
[CUSTOMER][NEUTRAL] I can help you with client status.
[CUSTOMER][NEUTRAL] Miss
[CUSTOMER][NEUTRAL] That number
[CUSTOMER][NEUTRAL] The call
[CUSTOMER][NEUTRAL] Um, yes. Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Thank you and then what is the patient's name, date of birth and.
[CUSTOMER][NEUTRAL] Um, yes. Patient's name is [PII]. Last name is [PII]. It's spelled [PII]. Date of birth is [PII]. And the policy number is 02583474.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then may I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK, and then may I please have the data service and the charge.
[CUSTOMER][NEUTRAL] Yes, date of service was [PII] and bill amount was $536 even.
[AGENT][NEUTRAL] OK. Then what was the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So what was the charge amount after the primary.
[CUSTOMER][NEUTRAL] Um, I'm sorry, do you mean like the patient responsibility, the, um, balance, remaining balance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. It's $40.
[AGENT][NEUTRAL] OK. All right. I'm gonna put you on a quick hold, Ms. [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] All right, I'm just like.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much Ms. [PII] for holding for me. I have the claim ready for you.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3477598.
[CUSTOMER][NEUTRAL] The claim number is 347.
[AGENT][NEUTRAL] The claim was denied because the office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Covered by the patient
[CUSTOMER][NEUTRAL] OK, um, just to confirm the claim number that you said it's 3477598?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. OK and you said that this claim was denied because of um patients plan does not cover office visit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct. OK, um, in this case, um, how could we know, uh, what kind of plan, um, does not cover office visit?
[AGENT][NEUTRAL] When the phone call is made to verify benefits and eligibility.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] The phone call is made to verify benefits and eligibility. Mhm.
[AGENT][NEUTRAL] That's how you know.
[CUSTOMER][NEUTRAL] That's how you
[CUSTOMER][NEUTRAL] Um, but, um, can you please explain me more details? What kind of plan plan does not cover office visit? Is there any specific plan? Mhm.
[AGENT][NEUTRAL] Oh, the name of
[AGENT][NEUTRAL] The name of the policy, the name of the plan is Medlink.
[CUSTOMER][NEUTRAL] The name of the policy, the name of the plan is [PII].
[CUSTOMER][NEUTRAL] How do you spell it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK. So this plan does not cover um office visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct. OK, thank you, can you please spell your name one more time?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] Yes ma'am, it's TO.
[CUSTOMER][NEUTRAL] [PII] Thank you, sorry. And the initial of your last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Thank you. Do you guys provide reference number or can I use your name as reference?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for the information. Sorry, that's all the information that I needed to know. Have a nice day.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII]. Thank you for calling APL.
[CUSTOMER][POSITIVE] You have a wonderful day too, Ms. [PII]. Thank you for calling ATL. Thank you.