AccountId: 011433970860
ContactId: 7f572a22-fe4f-4687-8ac8-faa65e612b0a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617770 ms
Total Talk Time (AGENT): 216871 ms
Total Talk Time (CUSTOMER): 142925 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/7f572a22-fe4f-4687-8ac8-faa65e612b0a_20250108T17:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. So this is [PII] calling from Mount Sinai Medical Center. I need to verify if you guys received a claim for a member and the status of the claim if you guys did.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, that will be 01967095.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] through the oh [PII] [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] This will be for [PII] bill amount 18,388 with 32 cents after primary pay 3,819 even.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, let me see if I can find this claim, and for future you can check claim status online through our website at [PII], and that's just optional and let's see, let me see.
[AGENT][NEUTRAL] OK, here it is. Let me pull the EOB one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'm waiting on the explanation of benefits to pull up.
[CUSTOMER][NEUTRAL] So you guys did receive it when it was received?
[AGENT][NEUTRAL] Um, let me see what it was received.
[AGENT][NEUTRAL] OK. So it looks like it was received on [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] You got a proof?
[AGENT][NEUTRAL] Yeah, we did send the payment. I'm just waiting for the details. It's taking a little bit to pull up.
[AGENT][NEUTRAL] All right, so it looks like we send a payment of $2,682.83 to the provider.
[AGENT][NEUTRAL] And it looks like with the payment of that check, they are so the benefit for the year.
[CUSTOMER][NEUTRAL] OK, when, and when did you guys send the payment? Pay it on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] single payment or both amount?
[AGENT][NEUTRAL] This is gonna be a single check, paper check?
[CUSTOMER][NEUTRAL] And what is the check number?
[AGENT][NEUTRAL] OK, the check number is 2019282.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] Claim number is 3542786.
[CUSTOMER][NEUTRAL] 6, give me a moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Reference number is going to be your name right until you.
[AGENT][NEUTRAL] My name into the mhm.
[CUSTOMER][NEUTRAL] Um, I do have another member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My time.
[AGENT][POSITIVE] I'm ready for the policy number whenever you are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that would be 02321234.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] This will be for [PII] [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] This is for.
[CUSTOMER][NEUTRAL] [PII] with the amount of 6,18755 after primary paid 1,269 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull this one and see if this is the correct claim.
[AGENT][NEUTRAL] All right, so this is it. OK, let me look at the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it was processed twice, um,
[AGENT][NEUTRAL] Let me give you the first claim and then I can give you the information on the second claim because it looks like it was processed twice for some reason. Um.
[CUSTOMER][NEUTRAL] I mean, um, if the second one is denied as a duplicate, which is going to be, um, I just need the main one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it is not it, it's both of them were pay um let me look at the most recent one and see why it was paid as well.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, let me look at that.
[AGENT][NEUTRAL] But I'm thinking it may be a revised um claim or something like that.
[AGENT][NEUTRAL] We're both pay.
[AGENT][NEUTRAL] I'm waiting on the image. I'm sorry, it's taking a little bit to pull up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What did you pay twice.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so it looks like the first one was paid correctly, so I'm not really sure why the second one was paid. I'll have to check on that one with the examiner, um, but the first one, which it was paid correctly because it was the full amount of $1,269 paid, um.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Let me give you the information on when we received that.
[AGENT][NEUTRAL] OK. So we received the claim on [PII], processed [PII]. And again, we send a benefit amount of $1,269 to the provider.
[AGENT][NEUTRAL] And the claim number whenever you're ready.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 2, I'm sorry, 354.
[AGENT][NEUTRAL] 2824.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When this um payment was made on and paid on which date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], both amounts single payment.
[AGENT][NEUTRAL] It's a single payment, paper check, single check.
[AGENT][NEUTRAL] And you need the check number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the checking number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. That was so thank you very much. Have a wonderful day.
[AGENT][POSITIVE] You as so much, [PII], and thank you for calling EPO. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.