AccountId: 011433970860
ContactId: d2ea8f80-5e29-48c7-9721-146f18ca6c46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475299 ms
Total Talk Time (AGENT): 173327 ms
Total Talk Time (CUSTOMER): 209327 ms
Interruptions: 10
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/d2ea8f80-5e29-48c7-9721-146f18ca6c46_20250519T20:20_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] May I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon, [PII]. My name is [PII]. I'm calling from Mount Sinai Medical Center. I'm trying to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Did you say that you were needing claim status?
[CUSTOMER][NEUTRAL] Did you say that you were needing status? Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, [PII]?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] I'm sorry, the what?
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] What is the member's policy number? Oh.
[CUSTOMER][NEUTRAL] That should be 0249.
[CUSTOMER][NEUTRAL] 19445
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry.
[CUSTOMER][NEUTRAL] The number 8
[AGENT][NEUTRAL] OK, OK. So, [PII], that's gonna be too many numbers.
[AGENT][NEUTRAL] You gave me 024919445. That's too many numbers.
[CUSTOMER][NEUTRAL] UJD 0249.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is on the ID card?
[CUSTOMER][NEUTRAL] Mm, that's the member ID that is on the ID card.
[AGENT][NEGATIVE] OK, then you need to repeat it because you gave me an extra you gave me too many numbers.
[CUSTOMER][NEUTRAL] Mm, OK, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, actually, that's the ID that's the ID number that I have on the car, on the car ID.
[AGENT][NEUTRAL] Call it
[CUSTOMER][NEUTRAL] 02419445
[AGENT][NEUTRAL] OK, that's not what you said before. Say that again. That's not what you said the first time.
[CUSTOMER][NEUTRAL] So that's not
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, the member ID I got is 02.
[CUSTOMER][NEUTRAL] 41
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] 45.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have, I have 3 additional digits ML 8 but I don't know if that is helpful for you. I mean, I don't know what is the correct uh ID number, just the numbers or the last three.
[AGENT][NEGATIVE] OK, but the first, yes, but the first, no, the first time you gave me the number, you said it was 024919445. That's too many numbers. The correct number is 02419445 and then the ML.
[CUSTOMER][NEUTRAL] The first time you gave me.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I got it. There is a there is an additional line.
[AGENT][NEGATIVE] Yes, that is not correct.
[CUSTOMER][NEUTRAL] I will update that on my system.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So just a moment please.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide today, [PII] will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is uh [PII].
[CUSTOMER][NEUTRAL] Date of birth, uh [PII], I'm sorry.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Sure. The of service, uh [PII]. total charges.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, total charges.
[CUSTOMER][NEUTRAL] $403.
[AGENT][NEUTRAL] 403.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so [PII], I do not have a claim on file for this number for that data service in the bill amount of $403.
[CUSTOMER][NEUTRAL] OK, so then, I do not have a claim on file for this number for that data service and the bill amount is $33.
[CUSTOMER][NEUTRAL] Mm, what, what about the total charges 337?
[AGENT][NEUTRAL] OK, so which charge is it? 403 or 337?
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Mm, I mean, OK, I have uh one charge in my system. I have another one on the claims, so I don't know what is the one that you have in your system.
[AGENT][NEUTRAL] OK, what is the correct bill amount?
[CUSTOMER][NEUTRAL] Mm, OK, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK [PII], uh, total charges should be 337.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that claim is on file for 337.
[CUSTOMER][NEUTRAL] OK, so that's why
[CUSTOMER][NEUTRAL] 3:30
[AGENT][NEUTRAL] And that claim was received on [PII] and it was denied on [PII].
[CUSTOMER][NEUTRAL] And that plan is on 121.
[CUSTOMER][NEUTRAL] It was 12225. Mhm. The claim number is 355.
[AGENT][NEUTRAL] The claim number is 3,554,270.
[CUSTOMER][NEUTRAL] 427
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] that all services are not covered by the above member policy.
[AGENT][NEUTRAL] The member supplemental plan does not cover office visit stat.
[CUSTOMER][NEUTRAL] The member supplement
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And if you need a copy of the EOB that has that remark on there now that you have the claim number you can print that by going to our portal.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Located at [PII].
[CUSTOMER][NEUTRAL] Located [PII].
[CUSTOMER][NEUTRAL] OK, but just to confirm, so in that case it should be patient responsibility, right?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Mm, I got it.
[CUSTOMER][NEUTRAL] OK, well thank you [PII] for that information. Can you repeat again the claim number?
[AGENT][NEUTRAL] 355-4270
[CUSTOMER][NEUTRAL] 3,554,270
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 4270.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] 3,554,273,554,270
[CUSTOMER][NEUTRAL] OK. 35.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] 70.
[CUSTOMER][POSITIVE] Thank you. I do appreciate that assistance. Uh, can you please tell me, uh, do you have a reference number maybe?
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] It would be my name along with today's date.
[CUSTOMER][NEUTRAL] It would be
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK. Well, is there?
[CUSTOMER][POSITIVE] Thank you [PII] I do appreciate it. Have a great day.
[AGENT][POSITIVE] Oh, you too, [PII]. So that's all I can help you with. Thank you again for calling APL and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] you have.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Yeah, bye-bye.
[CUSTOMER][NEUTRAL] Mm bye-bye.