AccountId: 011433970860
ContactId: c8e2dd3b-6efc-42d7-a265-905040c19565
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362230 ms
Total Talk Time (AGENT): 133384 ms
Total Talk Time (CUSTOMER): 127636 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/c8e2dd3b-6efc-42d7-a265-905040c19565_20250210T15:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling from Mount Sinai Hospital Medical Center to check a claim status. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing well, [PII] how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good. Thanks for asking.
[AGENT][NEUTRAL] Good. So you're needing to check claim status on one claim, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes, yes, [PII].
[AGENT][POSITIVE] Yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number is 024776.
[CUSTOMER][NEUTRAL] 90
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I need a service and total bill amount for him, please.
[CUSTOMER][NEUTRAL] Yeah, the, yeah, the date of service is [PII] with the charge amount of $482.26.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, you said the data service is [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's right, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get
[AGENT][NEUTRAL] OK, just a moment please, [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes, [PII].
[AGENT][NEUTRAL] It's still trying to load the information. OK, so as of now [PII], we have not received a claim for this data service and total bill amount for this member.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yeah, OK. Just a moment, [PII]. I need to check on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, if there is any reaction on your site, could you please check with that?
[AGENT][NEUTRAL] I'm sorry, what was, say that again, I didn't understand you.
[CUSTOMER][NEUTRAL] If there is any front front and rejection, rejection for on your side, could you please check with that?
[AGENT][NEUTRAL] We have not received a claim for this member for this state of service.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, OK, [PII]. So can I be uh patients eligibility?
[CUSTOMER][NEUTRAL] To resubmit the claim
[AGENT][NEUTRAL] Yes, this this limited benefit plan is uh excuse me, it is active with an effective date of [PII], and there is no term date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll get [PII], and can I get the
[CUSTOMER][NEUTRAL] Um, pay ready to resubmit the claim.
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] What payer ID do you have? So let's say since you said it was already submitted and we don't have it what?
[CUSTOMER][POSITIVE] Yeah, yeah, just a moment. Yeah, I want to go that, yeah.
[CUSTOMER][NEUTRAL] We don't, we have a Perry PSCSXS.
[AGENT][NEGATIVE] OK, I don't know what that is, that's not correct. Yes, so that's not correct for this number.
[CUSTOMER][NEUTRAL] That's what we have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the payer ID is 64556.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, quite crazy. And, and the mailing address to uh send a paper claim?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, [PII]. Thank you for that. And can I get the call reference number for this call?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You will use my name and today's date and then also suggest and once the claim has been processed, you you should also be able to check claim status by going to [PII].
[CUSTOMER][POSITIVE] Mhm. Yeah, it's easy. I'll do that. Thank you for that and have a good day. Bye-bye.
[AGENT][POSITIVE] OK, you're very welcome. Yes sir. Well, thank you for calling APL, and if that's all I can help you with, [PII], I hope you have a nice day also.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.