AccountId: 011433970860
ContactId: 83a4d3b1-5a71-4433-9c99-d36727d56237
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648250 ms
Total Talk Time (AGENT): 172289 ms
Total Talk Time (CUSTOMER): 188119 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/83a4d3b1-5a71-4433-9c99-d36727d56237_20250108T20:32_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], good afternoon. This is [PII] calling from Mount Sinai Medical Center. I need to get the status of the claim.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] As of right now I'm just 2.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] [PII] policy policy ID number is 0250624.
[AGENT][NEUTRAL] And the phone was kind of choppy there. Did you say 2, I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Not the phone number, the policy number.
[CUSTOMER][NEUTRAL] 0 to 5, yes.
[AGENT][NEUTRAL] 60624.
[CUSTOMER][NEUTRAL] Yes, 00624 mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, can you just say the whole policy over again because it was choppy and now I'm lost. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, OK, 02500624.
[AGENT][POSITIVE] OK, here we go. Hold on one moment, thank you for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII] build the amount.
[CUSTOMER][POSITIVE] Let me know you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Um, 3,40769 cents after primary pay 7 with 56 cents.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm trying to received this claim on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 3256.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] OK, because I did see that as for the EOP it was um.
[CUSTOMER][NEUTRAL] And um claim was denied as a duplicate.
[AGENT][NEUTRAL] On what claim?
[AGENT][NEUTRAL] This this plan we just went over.
[CUSTOMER][NEUTRAL] On the explanation of uh benefit it says the maximum benefit payable for the date of service. The above reference claim appears to be as a duplicate. I just wanted to make sure that.
[CUSTOMER][POSITIVE] Um, that was accurate.
[AGENT][NEUTRAL] Um, I'm not showing the duplicate part, but yes, the, the max was paid on the, there's two claims y'all y'all um filed on that day and the other claim.
[AGENT][NEUTRAL] The max was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Payable.
[CUSTOMER][NEUTRAL] OK I do have another member.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] And this was one.
[CUSTOMER][NEUTRAL] Let me send this to be posted then.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, on the phone.
[CUSTOMER][NEUTRAL] Uh, let me give you the all the members info.
[CUSTOMER][NEUTRAL] Yes, um, ID number let me know when you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] That will be 02517406.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is there any other first name for the member?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, and thank you so much for verifying his information. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII] built on $41,857.28 24 cents after primary paid $2,247.67.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] All right. So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 2926.
[AGENT][NEUTRAL] Hold on one moment, why is this two lines? OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim?
[AGENT][NEUTRAL] A total
[CUSTOMER][NEUTRAL] One? December what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we paid out on the claim a total.
[CUSTOMER][NEUTRAL] How much
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] How much um did you guys paid?
[AGENT][NEUTRAL] We paid out on the claim $2,247.67.
[AGENT][NEUTRAL] And would you like that checking information?
[CUSTOMER][NEUTRAL] Full amount.
[CUSTOMER][NEUTRAL] That was a single payment?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Check number?
[AGENT][NEUTRAL] 2019332.
[CUSTOMER][NEUTRAL] Um, could you be able to send me a fax of the remittance with the copy of the check front and back?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 305674.
[AGENT][NEUTRAL] 565 26, OK.
[CUSTOMER][NEUTRAL] 2652.
[AGENT][NEUTRAL] OK, did you need to issue a clear date for the check?
[CUSTOMER][NEUTRAL] No, just a copy of the check front and back and the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I put the request in for the check, the um copy of the check to be faxed to you, and I'm emailing the explanation of benefits to you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh man that was so.
[AGENT][NEUTRAL] Alrighty, well, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No that was all thank you very much appreciate it.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a good day and happy New Year.
[CUSTOMER][NEUTRAL] You too, likewise bye.
[AGENT][POSITIVE] Thank you. Bye bye.