AccountId: 011433970860
ContactId: a28de0ed-28fe-4ca6-a0c3-e33fd3b600c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314200 ms
Total Talk Time (AGENT): 101279 ms
Total Talk Time (CUSTOMER): 203343 ms
Interruptions: 10
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/a28de0ed-28fe-4ca6-a0c3-e33fd3b600c9_20250506T16:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hello [PII], this is [PII]. I'm calling on behalf of Mount Sinai Medical Center to check payment status for one of our patients, please.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, I can help you, [PII]. What's the policy number.
[CUSTOMER][NEUTRAL] Um, yes, um, phone number is [PII]. Yeah.
[CUSTOMER][NEGATIVE] This is um there is no extension for this number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the policy, yes, member's policy number is 2456394.
[AGENT][NEUTRAL] And the policy?
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the name Yes, patient's name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you for that information, [PII], one moment.
[CUSTOMER][POSITIVE] Oh thank you for that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that the patient has an active policy number 257.
[CUSTOMER][NEUTRAL] So I do show that the patient has a policy number 257.
[AGENT][NEUTRAL] 88884.
[CUSTOMER][NEUTRAL] 888 4.
[AGENT][NEUTRAL] And this policy became effective [PII].
[CUSTOMER][NEUTRAL] And this policy became effective [PII].
[AGENT][NEUTRAL] Uh, it is currently active.
[CUSTOMER][NEUTRAL] It is currently active. Mhm.
[AGENT][NEUTRAL] Uh, and the policy number you provided, it, it termed [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, so the policy number, the policy, um.
[CUSTOMER][NEUTRAL] Term on [PII], this policy number?
[AGENT][NEUTRAL] The policy number that you provided is no longer active as of [PII].
[CUSTOMER][NEUTRAL] The policy number that you provided is no longer active as of January.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But um the claim that I have here is for last year on [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, so we will look under that policy. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the total bill?
[CUSTOMER][NEUTRAL] And what
[CUSTOMER][NEUTRAL] Um, total amount it's $519.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, I have a claim number as well because I'm seeing here that you guys process this claim.
[AGENT][NEUTRAL] OK, and what is that number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 347-6185.
[AGENT][NEUTRAL] OK, so do you have a question regarding how the claim was processed?
[CUSTOMER][NEUTRAL] you have a question regarding? Yes, um, I'm seeing here that there is a payment for $119.90. That's correct, right? And for this is for CPT 51,700. What about the CPT 99213 you guys deny this claim as non-covered charges. May I know why?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm. On the explanation of benefits that you may have received, it says that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Who's on the explanation of benefits that you may have received it says that office visits are not covered.
[CUSTOMER][NEUTRAL] This policy
[CUSTOMER][NEUTRAL] Oh, so office business is not, is not um.
[CUSTOMER][NEUTRAL] Under this patient benefit plan?
[AGENT][NEUTRAL] Not covered under this policy, correct.
[CUSTOMER][NEGATIVE] Not covered under
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. OK, so if I call you again, uh, I mean, I have like the same um issue here, how will we know about what kind of policy does cover um office visit and um the others not.
[AGENT][NEUTRAL] OK, so policy number 2456394 does not cover office visits. Do you want me to check under the new policy to verify if office visits are covered under that one?
[CUSTOMER][NEUTRAL] OK, so policy number
[CUSTOMER][NEUTRAL] 94 does not have.
[CUSTOMER][NEUTRAL] Do you want me to check under the new policy to verify.
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] All right, so the physician's visit fee is not covered, but covered treatment in the office can be considered under the new policy.
[CUSTOMER][NEUTRAL] Alright, so this is this.
[CUSTOMER][NEUTRAL] Treatment in the
[CUSTOMER][NEUTRAL] OK. Please, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And there is any plan that covers office visit under this policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, neither policies cover office visits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Offices. Oh, OK, got it. OK, [PII], thank you so much for the information. Do you guys provide a reference number or can I use your name as reference?
[AGENT][NEUTRAL] Oh, we do when you're
[AGENT][NEUTRAL] You're welcome, and we do not provide reference numbers, but you can use my name and today's date as your reference. It's [PII].
[CUSTOMER][POSITIVE] You're welcome and
[CUSTOMER][NEGATIVE] Never can use my name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial last name is [PII]. And any other questions, [PII]?
[CUSTOMER][NEUTRAL] First initial last name is [PII]
[CUSTOMER][POSITIVE] Um, no, that will be all. Thank you so much for the information. Have a nice day, [PII].
[AGENT][POSITIVE] You, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.