AccountId: 011433970860
ContactId: 8374fc7d-ca8b-4560-85a3-ae7d1eea8ff9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 717690 ms
Total Talk Time (AGENT): 189485 ms
Total Talk Time (CUSTOMER): 267086 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/8374fc7d-ca8b-4560-85a3-ae7d1eea8ff9_20250327T17:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] from Mount Sina Center. I'm calling for checking claim status.
[AGENT][NEUTRAL] Yeah, I could check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Yeah, I can check on the phone for you. I'm sorry, what did you say your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Got you, OK, and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sorry, OK, and then can I get a good call back number from you?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] The policy
[CUSTOMER][NEUTRAL] Um, yes, let me check.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The member's ID is 020818559 M as in mom, L Lima 7.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] OK, and what was the name and date of birth for the.
[CUSTOMER][NEUTRAL] The member's name is [PII] and date of birth [PII].
[AGENT][NEUTRAL] OK, I apologize, [PII]. I think I might have misheard that policy number. Could you repeat that for me?
[CUSTOMER][NEUTRAL] OK, I apologize, [PII]. I think I might have misheard that policy number. Could you repeat that for me? Yes. Yes. 022.
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] 859.
[CUSTOMER][NEUTRAL] And Mom
[CUSTOMER][NEUTRAL] L Lima 7.
[AGENT][NEUTRAL] OK, thank you that's it I appreciate you verifying that uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] OK, thank you. That's it. I appreciate you verifying that. And what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII]. Yes.
[AGENT][NEUTRAL] OK, and then what was that bill amount, please?
[CUSTOMER][NEUTRAL] What was that bill amount please?
[CUSTOMER][NEUTRAL] Um, the bill amount is.
[CUSTOMER][NEUTRAL] Um, 784.
[AGENT][NEUTRAL] 784
[CUSTOMER][NEUTRAL] With 40.
[AGENT][NEUTRAL] Uh, did you say 40 cents? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, did you say 40s? I'm sorry. Yeah.
[AGENT][POSITIVE] OK, alright, thank you one moment please.
[CUSTOMER][POSITIVE] OK, all right, thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry [PII], what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Mount Sinai Center.
[AGENT][NEUTRAL] Do you have that tax ID by chance?
[CUSTOMER][NEUTRAL] Yeah, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the tax ID number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, got it. Thank you. So I do have one claim uh from this provider for that date of service. That was for the amount of $337 even. Is that the amount after a major medical paid?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Um, I'm sorry?
[AGENT][NEGATIVE] The only claim I have on file for this state of service from this provider is for $337 even.
[CUSTOMER][NEUTRAL] 9 784.
[AGENT][NEUTRAL] OK then it appears that we've not received that claim.
[CUSTOMER][NEUTRAL] received that. OK, so we need to resubmit again, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh, we need to resubmit again this claim because you didn't receive it.
[AGENT][NEUTRAL] Correct, we, we have not received that claim. I've got a mailing address, a fax number, and a payer ID if you'd like.
[CUSTOMER][NEUTRAL] OK. So, the, um, do you have the mail, the mailing address to resubmit this claim again?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, uh, that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Thank you so much. So, you said [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Uh, can you help me with another, with
[CUSTOMER][NEUTRAL] Another patient, please.
[AGENT][NEUTRAL] Uh, for a different member?
[CUSTOMER][NEUTRAL] for a different
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, give me just a moment I'll let you know when I'm ready to proceed with that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, um, I'm ready for that next policy number, [PII].
[CUSTOMER][NEUTRAL] OK, give me a second, um, well, the policy number is 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 465.
[CUSTOMER][NEUTRAL] 728 M. L. Lima 7.
[AGENT][NEUTRAL] OK, and uh the name and date of birth for this number, please?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then uh what was that bill amount, please?
[CUSTOMER][NEUTRAL] The bill amount is $536.
[AGENT][NEUTRAL] 536. OK, thank you, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, uh, so we did receive this claim, [PII]. Uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, you said these benefits, this service is not covered on the um um members policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so this is patient responsibility, right?
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So it is provider responsibility, right?
[AGENT][NEUTRAL] It's up to the provider of what is patient responsibility we don't say what that is.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much.
[CUSTOMER][NEUTRAL] So, um, can you help me with the last member is with um another patient?
[CUSTOMER][NEUTRAL] I mean, I know, maybe the same reason, but I just want to make sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure, um, did you need any further information for this number?
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] OK, alright, one moment, um, I'll let you know when I'm ready for that last policy number.
[CUSTOMER][NEUTRAL] OK, all right
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I'm ready for that last policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, the next one is the members.
[CUSTOMER][NEUTRAL] ID 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 107246 M. L. Lima 8.
[AGENT][NEUTRAL] OK and then uh the name and date of birth for this number, please?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that bill amount, please?
[CUSTOMER][NEUTRAL] 337.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, yes, so we received this one as well. That now reason is the same as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got it, thank you so much.
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] And do you have
[CUSTOMER][NEUTRAL] Uh, yeah, do you have a reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last [PII]
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, OK, and last name initial [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In today's day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for your help.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you bye bye.