AccountId: 011433970860
ContactId: 89e2edc3-7f2e-4196-8a8f-f8a14a129b11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331859 ms
Total Talk Time (AGENT): 136199 ms
Total Talk Time (CUSTOMER): 100304 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/89e2edc3-7f2e-4196-8a8f-f8a14a129b11_20250306T15:50_UTC.wav
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[AGENT][NEUTRAL] Alright, thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] I'm calling from
[AGENT][NEUTRAL] I'm sorry. I, I can't hear you.
[CUSTOMER][NEUTRAL] Oh, I'm
[CUSTOMER][POSITIVE] Uh, really very sorry for that. Myself, [PII]. I'm calling from Mount Hospital Medical Center. I'm looking upon a claim status. Could you please help me with that?
[AGENT][NEUTRAL] Uh, yes, sir. I can verify claim status for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] Uh my name is [PII]. Could you please help me with yours? That is [PII] Last name initially is [PII].
[AGENT][NEUTRAL] OK, thank you. Uh, my name is [PII], last initial [PII]
[AGENT][NEUTRAL] And has she, do you have that policy number, please?
[CUSTOMER][NEUTRAL] Yes, that is 02477690.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment, please.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, it's [PII], sorry, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] This name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of services of [PII] and the bill amount is $482.26.
[AGENT][NEUTRAL] OK, thank you. And do you have uh the balance after primary?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's that amount, please?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the balance after primary, please?
[CUSTOMER][NEUTRAL] Uh, that is 42.26.
[AGENT][NEUTRAL] $42.46.
[CUSTOMER][NEUTRAL] 26 cents. That is $482.26.
[AGENT][NEUTRAL] No, sir. I'm asking the balance. Oh, I apologize. There's no secondary. Give me one moment, and you're calling from again? I apologize.
[CUSTOMER][NEUTRAL] I'm calling from Mount Sinai Hospital Medical Center.
[AGENT][NEUTRAL] OK, thank you. And while I'm looking at claim information, just to let you know we do have an online service center where providers can check claim status as well as print out EOB. That site is at [PII].
[AGENT][NEUTRAL] And I show this claim process is a covered diagnostic tests are limited to MRI, CT or colonoscopy. Other diagnostic test is not covered under this policy, therefore benefits are not payable for this service date.
[CUSTOMER][NEUTRAL] Uh, we have received the EOB, uh, in that we have received their denial that, uh.
[CUSTOMER][NEUTRAL] Uh, uh, the claim was denied for non-covered charges. Could you please help me why it was denied for the non-covered.
[AGENT][NEUTRAL] Because they insured diagnostic benefit only covers for MRI, CT, or colonoscopy. Any other diagnostic test is not covered under the policy.
[CUSTOMER][NEUTRAL] OK, could you please, uh, go a little bit slow? I have to make a note down, uh.
[AGENT][NEUTRAL] Sure. Under the policy, the diagnostic tests that are covered are MRI, CT, or colonoscopy.
[AGENT][NEUTRAL] Any other diagnostic MRI, CT, colonoscopy?
[CUSTOMER][NEUTRAL] Uh, MRI
[AGENT][NEUTRAL] And any other diagnostic test is not covered for the policy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Patient plan only covers the MRI, CT, and colonopic uh uh TX right diagnosis.
[AGENT][NEUTRAL] MRI, CT, or colonoscopy. Those are only covered diagnostic tests on this plan.
[CUSTOMER][NEUTRAL] That is M I or M M R I.
[AGENT][NEUTRAL] MRI.
[CUSTOMER][NEUTRAL] OK, and CT that is C as in Charlie, T [PII], right?
[AGENT][NEUTRAL] Yes, CT.
[CUSTOMER][NEUTRAL] Yes, and colonopic are only covered under the patient policy and no other diagnosis are covered.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just allow me a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Would you please help me with the call reference for this patient?
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Thank you so much have a nice day. Take care bye bye.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL. Bye.