AccountId: 011433970860
ContactId: d2b0464a-9f7b-4378-8de8-060b24659496
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358850 ms
Total Talk Time (AGENT): 128893 ms
Total Talk Time (CUSTOMER): 117473 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/d2b0464a-9f7b-4378-8de8-060b24659496_20250113T13:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning thank you for
[CUSTOMER][NEUTRAL] Hello, good morning, [PII]. My name is [PII]. I'm calling from Mount Sinai Medical Center, and I would like to check uh claim status, please.
[AGENT][NEUTRAL] OK, Roger, OK, you're needing to check claim status for a number, is that correct?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Did you say that you are needing to check claim status?
[CUSTOMER][POSITIVE] That is correct, thank you very much.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number that you're calling on?
[CUSTOMER][NEUTRAL] Sure. It is 001.
[CUSTOMER][NEUTRAL] 678152
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and Roger, got 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 date of birth?
[CUSTOMER][NEUTRAL] Thank you. Patient's name would be [PII] The date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what was the patient's name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] What's the first name, last name [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] All right. It would be [PII].
[CUSTOMER][NEUTRAL] For $228.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The received date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 1476.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial is office visits are not covered under the supplemental policy.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][POSITIVE] Uh, yeah, I'm sorry. Thank you. I was, I was taping there.
[AGENT][NEUTRAL] Oh, OK. That's OK. That's uh, the line just got, that's OK. The line just got very quiet and I thought that maybe the call might have dropped.
[CUSTOMER][NEUTRAL] 00, sorry, sir. OK, um, just allow me one second please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Alright, and just one question, uh, [PII], alright, this would be or the balance would be patient responsibility?
[AGENT][NEUTRAL] We did not determine patient responsibility, [PII], that would be up to the primary, um, excuse me, to the provider.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may go to our portal.
[AGENT][NEUTRAL] At secured.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Um, yeah, I already, uh, tried to search on the portal, however, I, I couldn't.
[AGENT][NEUTRAL] Uh, what's the claim number?
[CUSTOMER][NEUTRAL] I, I couldn't find you because I didn't have the claim number.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Just, just 111 more time. I just want to, you know, uh, stay clear about this. So you're now stating uh.
[CUSTOMER][NEUTRAL] Any patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] All right. So who determines in this case, so the hospital, you said, I think, right.
[AGENT][NEUTRAL] The provider.
[AGENT][NEUTRAL] The provider, mhm.
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][POSITIVE] All right, [PII], thank you very much for your help and for your time.
[AGENT][POSITIVE] Yes, you're very welcome. Yes, you're very welcome.
[CUSTOMER][NEUTRAL] It would be everything for now. Thank you. And I will need the call reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][POSITIVE] All right, thank you very much.
[AGENT][POSITIVE] You are certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh, not now. Thank you though.
[AGENT][POSITIVE] OK. Well, you're welcome. And again, thank you for calling APL. I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Same for you, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.