AccountId: 011433970860
ContactId: 73f6831a-62cf-43e9-abbb-b25cbcf3a9ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616030 ms
Total Talk Time (AGENT): 143131 ms
Total Talk Time (CUSTOMER): 256788 ms
Interruptions: 12
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/73f6831a-62cf-43e9-abbb-b25cbcf3a9ca_20250331T20:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL.
[CUSTOMER][POSITIVE] Thank you for calling HO.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] He you
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] from Mount Sinai Center. Um, I want to check in, I want to check claim status.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] The patient's policy number is 1,067,550.
[AGENT][NEUTRAL] Thank you. And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And if I can get the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, the patient's name is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much, [PII]. And then what was the date of service?
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And what was the date of service?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And the build amount?
[CUSTOMER][NEUTRAL] In the build out.
[CUSTOMER][NEUTRAL] Yeah 536.
[AGENT][NEUTRAL] 5:36.
[CUSTOMER][NEUTRAL] 5:36. Yes.
[AGENT][NEUTRAL] Do you have an amount by chance after the primary?
[CUSTOMER][NEUTRAL] an amount by chance after the primary?
[CUSTOMER][NEUTRAL] Yes, it's um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] 60 $60.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So we did receive a claim for this state of service, claim was received on [PII].
[CUSTOMER][NEUTRAL] So we did receive a claim for this date of.
[CUSTOMER][NEUTRAL] on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the.
[CUSTOMER][NEUTRAL] The benefit payment in the.
[AGENT][NEUTRAL] Amount of $60.
[CUSTOMER][NEUTRAL] Amount of $60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] I want to know general information or claim status because I cannot see information related about it if was denied or something like that.
[AGENT][NEUTRAL] All right, [PII], what was that date again? I'm sorry, it went away.
[CUSTOMER][NEUTRAL] What was that date again? I'm sorry, it went away.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Do you have it?
[AGENT][POSITIVE] Mhm. I have it here. Thank you.
[CUSTOMER][POSITIVE] I have it here. Thank you. OK.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] I apologize, [PII]. OK, so.
[CUSTOMER][NEUTRAL] I apologize, [PII], OK, so.
[AGENT][NEUTRAL] The claim was received.
[CUSTOMER][NEUTRAL] The claim was received.
[AGENT][NEUTRAL] The received date again was [PII].
[CUSTOMER][NEUTRAL] The receipt
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The benefit payment was $25. The claim was processed on [PII].
[CUSTOMER][NEUTRAL] The benefit payment was $25. The claim was processed on [PII].
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] With a single cha
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you need the claim number or check number?
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] OK, yeah, actually I see it um.
[CUSTOMER][NEUTRAL] The bill amount was $60 and you paid $25.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, but what about um the $35?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The remaining, I want to know if it was denied or rejected.
[AGENT][NEUTRAL] Uh, this is the max benefit payable for this state of service.
[CUSTOMER][POSITIVE] Uh, this is the max benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the 2 $25 that you already paid, it was the um the max payable right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you did you deny the the remaining?
[AGENT][NEUTRAL] It doesn't show any denial. No, it just says with this payment, the maximum benefit amount for services provided has been exhausted.
[CUSTOMER][NEUTRAL] Or not for services providers.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Thank you so much. OK, um.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was there anything else?
[CUSTOMER][NEUTRAL] Can you help me? Yes, I have another patient. Can you help me with that, please?
[AGENT][NEUTRAL] Yeah, absolutely. What's that patient's policy number?
[CUSTOMER][NEUTRAL] What's that [PII]'s policy number?
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, the.
[CUSTOMER][NEUTRAL] Patient's ID is 02.
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] 0683.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you and date of service?
[CUSTOMER][NEUTRAL] You do your service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] And you build them out
[CUSTOMER][NEUTRAL] The billed amount is $135.
[AGENT][NEUTRAL] Thank you. And then after primary, what was the amount?
[CUSTOMER][NEUTRAL] And and then after primary, what was the amount?
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] 57.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] And my system shows policy benefits has been exhausted.
[AGENT][NEUTRAL] Let me double check on this claim because I'm seeing a different amount but.
[CUSTOMER][NEUTRAL] Let me double check on this claim because I'm seeing a different amount but.
[AGENT][NEUTRAL] I just may be in my system. One moment please.
[CUSTOMER][NEUTRAL] Just maybe
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, this claim was received on [PII].
[CUSTOMER][NEUTRAL] So yes, this claim was received on [PII].
[AGENT][NEGATIVE] It was denied showing the maximum benefit amount for treatment during this has already been exhausted. There were no additional benefits payable.
[CUSTOMER][NEGATIVE] It was denied showing the maximum benefits an amount for treatment.
[CUSTOMER][NEGATIVE] there were no additional benefits to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it, thank you so much.
[AGENT][NEUTRAL] No problem, [PII].
[CUSTOMER][NEUTRAL] And do you have a reference number for this call?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial than today's date.
[CUSTOMER][NEUTRAL] For a call references.
[CUSTOMER][NEUTRAL] With my last initial.
[AGENT][NEUTRAL] My name again is [PII], that's [PII]
[CUSTOMER][NEUTRAL] [PII], that's [PII]
[AGENT][NEUTRAL] Last initials [PII].
[CUSTOMER][NEUTRAL] OK, your name, S as in [PII], your last name initial, [PII], and today's date, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for your help.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye-bye.