AccountId: 011433970860
ContactId: 9e60c567-5d3e-44a3-b40a-6d0d62c15b48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377140 ms
Total Talk Time (AGENT): 132586 ms
Total Talk Time (CUSTOMER): 81117 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/9e60c567-5d3e-44a3-b40a-6d0d62c15b48_20250205T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] and I'm calling from Montana Hospital. I'm wondering if I can get claim status.
[AGENT][NEUTRAL] I guess Ms. [PII], I can help you with claim status. Um, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number I have is 02477690.
[AGENT][NEUTRAL] OK, let me look him up for us real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $67,043.98.
[AGENT][NEUTRAL] OK, and what was the name of the facility you were calling from? I didn't catch it in the beginning of the call.
[CUSTOMER][NEUTRAL] Mount Sinai Hospital Medical Center.
[AGENT][POSITIVE] OK, thank you so much Ms. [PII]. It's gonna be a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII] with you again. So looking for um data service 12-19 of 2024 in the amount of $67,000.67 $47,0043.98 sorry.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not finding the claim on file for that amount.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Did you want the claim number?
[AGENT][POSITIVE] Yes, absolutely. Yes, please.
[CUSTOMER][NEUTRAL] I have claim number 35496008.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] Because I don't see it, um, 192024.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I see the difference.
[AGENT][NEUTRAL] 477,690 and 691.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is off by one digit.
[AGENT][NEUTRAL] That's why I wasn't able to find it on the other one.
[AGENT][NEUTRAL] Alright, let me look.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And while you're looking at that, could you give me the first initial of your last name?
[AGENT][NEUTRAL] Yes ma'am it's A.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the claim was denied because um this policy does not provide a benefit for surgical procedures.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, when was the claim received?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] Let me write down that policy number so I don't lose it because it was different than the first one. OK, let me look over there real quick.
[AGENT][NEUTRAL] OK, the, um,
[AGENT][NEUTRAL] Claim was reported.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then it, it doesn't cover um the surgical procedures.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is this, does this thing go to patient responsibility? Is there a patient responsibility on there?
[AGENT][NEUTRAL] No, ma'am, we don't ever do patient responsibility because, because that's determined by the provider.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I go ahead and get a call reference please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. You have a great day.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. You have a blessed night. Thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] All right, bye bye.