AccountId: 011433970860
ContactId: 75665540-b1de-4855-a823-381bd88c5c73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1676880 ms
Total Talk Time (AGENT): 292945 ms
Total Talk Time (CUSTOMER): 210914 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/75665540-b1de-4855-a823-381bd88c5c73_20250408T17:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, good afternoon. I'm calling to get claim status, please.
[AGENT][POSITIVE] Yes, of course.
[AGENT][POSITIVE] And who do I have the pleasure?
[CUSTOMER][NEUTRAL] And may I get your name, please?
[AGENT][NEUTRAL] My name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] Yes. And then can I have your name, please?
[CUSTOMER][NEUTRAL] Yeah this is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02199664.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, are you calling from a provider's office?
[CUSTOMER][NEUTRAL] Yes. Mount Sinai Medical Center.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK, thank you. And then the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, and then do you have the date of service for the claim you're looking for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have the charge amount?
[CUSTOMER][NEUTRAL] 5,087548.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And you said 6-02-2025 was the date?
[CUSTOMER][NEUTRAL] From the [PII].
[AGENT][NEGATIVE] Sorry, you're breaking up.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just 1 2nd.
[AGENT][NEUTRAL] OK, and this was for an ER visit, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. Can I please put you on a brief hold while I look into this claim?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that OK? OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 3582195.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 21
[AGENT][NEUTRAL] 355802.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey, thank you for holding.
[AGENT][POSITIVE] Just, just one more second. I think I found the claim and I can tell you exactly.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What the status is of this?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we are still awaiting copies of the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] It was 5, 325.
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] It was packed on 325.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] Hello, are you there?
[CUSTOMER][NEUTRAL] Yeah, here.
[AGENT][NEUTRAL] Oh, sorry, it cut out for a minute.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it looks like we paid $200.
[AGENT][NEUTRAL] And the reason why the rest was not covered was due to this check, the maximum benefit payable for this state of service has been met already.
[CUSTOMER][NEUTRAL] $200 OK.
[CUSTOMER][NEUTRAL] When it was paid.
[AGENT][NEUTRAL] Yeah, $200 was paid already, and that was.
[CUSTOMER][NEUTRAL] No, when, when it was.
[AGENT][NEUTRAL] Let's see, it was paid, let me.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] It was paid [PII].
[CUSTOMER][NEUTRAL] Bulk amount or single payment?
[AGENT][NEUTRAL] It was a single payment of $200.
[CUSTOMER][NEUTRAL] Would you be able to fax me the copy of the check from and back?
[CUSTOMER][NEUTRAL] What is the check number?
[AGENT][NEUTRAL] The check number is 2035908.
[CUSTOMER][NEUTRAL] 2203.
[AGENT][NEUTRAL] 59
[AGENT][NEUTRAL] 08.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] And the claim number for this one is 358.
[AGENT][NEUTRAL] 21
[AGENT][NEUTRAL] 88.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a moment, I do have another number.
[AGENT][NEUTRAL] OK, you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next member ID number will be
[CUSTOMER][NEUTRAL] 018.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 23108.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and then can you verify the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], um, [PII].
[CUSTOMER][NEUTRAL] She would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][POSITIVE] OK, I see. Thank you.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And then do you have a data service and uh the amount for that one as well?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of 15,0624 23.
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Oh, hold on, give me a second.
[CUSTOMER][NEUTRAL] But this one I do see that it got paid, but it got paid only 500. Um, the rest is patient responsibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, just one second. I can tell you the reason why.
[CUSTOMER][POSITIVE] It's funny because on [PII] I called in.
[CUSTOMER][NEUTRAL] Saying that the claim was denied needing a complete primary insurance COV. The claim was faxed on [PII]. So we received a payment from you guys on the amount of 500, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the data service was 1220, [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, so we paid $500.
[AGENT][NEUTRAL] And it looks like for this policy and this benefit.
[AGENT][NEUTRAL] Uh, the check, the maximum benefit payable for this state of service has been met after we paid the $500 and
[CUSTOMER][NEUTRAL] But how, but if that, if you guys were needing the primary insurance, you'll be on the [PII].
[CUSTOMER][NEGATIVE] How is it paid on [PII]? Pay received makes no sense.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me put you on a brief hold while I get with a colleague and go over this one, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, 3571994.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I have 3 different claim numbers.
[AGENT][NEUTRAL] And it looks like I'm not sure, do you wanna write these claim numbers down?
[CUSTOMER][NEUTRAL] No, I mean, I am just um calling in regards to the one that it got paid.
[AGENT][NEUTRAL] OK, so for that claim, we paid 500 on [PII] and.
[AGENT][NEUTRAL] It looks like for this policy,
[AGENT][NEUTRAL] It says they have met their maximum benefit.
[AGENT][NEUTRAL] For this data service, so the reason why the other two claims were denied.
[AGENT][NEUTRAL] So one of the claims was denied because we are awaiting the EOB and then we have another one on file, but it's just a duplicate. So if you needed further assistance with why we are awaiting the EOB.
[AGENT][NEUTRAL] Then we'll have to.
[CUSTOMER][NEUTRAL] No, no, that's fine. What is the claim number to the one that got paid?
[AGENT][NEUTRAL] So the one that was paid is 357.
[AGENT][NEUTRAL] 1994.
[CUSTOMER][NEUTRAL] OK. So the rest is patient responsibility, right?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes. And so with this benefit, it's the reason why we only paid the $500 is because
[CUSTOMER][NEUTRAL] No, that's why you told me they met, they met their maximum benefit, yeah. So that's what I'm asking is um patient responsibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it's
[AGENT][NEUTRAL] Yes, it's, uh, paid per calendar day is why we only covered the.
[AGENT][NEUTRAL] The 500.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[CUSTOMER][NEUTRAL] Reference number would be your name, right?
[AGENT][NEUTRAL] Yes, and we do not determine patient's responsibility. We're not a major medical plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But yes, it would be my first name, which is [PII]. It'd be [PII]
[AGENT][NEUTRAL] And then my last initial is [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that was all. Thank you very much, appreciate it.
[AGENT][NEUTRAL] Yeah. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that was so.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] OK, thank you. Bye.