AccountId: 011433970860
ContactId: fdf9f024-0cb9-496d-a1f5-1ee390b182d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 925780 ms
Total Talk Time (AGENT): 247863 ms
Total Talk Time (CUSTOMER): 154765 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/fdf9f024-0cb9-496d-a1f5-1ee390b182d6_20250604T19:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon, [PII]. This is [PII] calling from Mont Sinai Medical Center. I need to get the status of the claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] with the policy number of 01960246.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] This will be for [PII] with the billed amount of 27,835 15 cents.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I just located the claim. I'm waiting for it to come up now. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider on the claim provider's office, I'm sorry.
[CUSTOMER][NEUTRAL] Mount Sinai Medical Center.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 5772.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Because the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] Could you be able to fax me a copy of the um EOP?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's a
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] Wait, the fax?
[AGENT][NEUTRAL] And that's Attention [PII]?
[CUSTOMER][NEUTRAL] Yes, so you say that it was the maximum um allowable has been paid by the primary?
[AGENT][NEUTRAL] Mhm. The maximum benefit for this data service has, so by the time your claim came in, we had already paid the max to another claim.
[CUSTOMER][NEUTRAL] has been met, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So I am faxing the explanation of benefits over to you now. And was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Yes, I do have another member.
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the reference number is your name with today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] You said it's a different member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me note this policy. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What did I just do? I think I might have deleted something while I was trying to type.
[AGENT][NEUTRAL] Um, 3605772, I did. OK.
[AGENT][NEUTRAL] 772-772. Where are you? 772. Wait, what is it? 360.
[AGENT][NEUTRAL] Um, 527, so it's probably 28.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for the wait and um I just faxed that over to you, so you should be receiving an explanation of benefits shortly. And may I have the next member's policy number?
[CUSTOMER][NEUTRAL] 01673441
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] This will be for [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] [PII] with the billed amount of 7,64875.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] I received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 5206.
[AGENT][NEUTRAL] And on [PII], the claim, uh, we paid out on the claim to the provider?
[AGENT][NEUTRAL] A total of 1,26.
[CUSTOMER][NEUTRAL] When on the
[CUSTOMER][NEUTRAL] Paid on which date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The payment was $1,269.
[CUSTOMER][NEUTRAL] Check number?
[AGENT][NEUTRAL] 204-6352.
[CUSTOMER][NEUTRAL] OK. Single payment, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK awesome, give me a moment.
[CUSTOMER][NEUTRAL] Do you have another member?
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have a few, but I know you guys do 3.
[AGENT][NEUTRAL] OK, and did you need this explanation of benefits um faxed over to you as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so I'm sending the fax over to you now. Hold on one moment.
[AGENT][NEUTRAL] Alright, I just sent the 2nd 1 over to you. Let me note this policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] This will be 02501736.
[AGENT][NEUTRAL] 02501736.
[CUSTOMER][NEUTRAL] 02 50 1736.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII] with the billed amount of 6,56202.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, so showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 4365.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] And did you need a copy of this explanation of benefits also?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 522. OK, I'm faxing this one over to you now. Hold on one moment.
[AGENT][POSITIVE] Alright, and the 3rd 1 has been faxed over to you, so you should be receiving that shortly. If you haven't received any of them by the by the end of day, um, just give us a call and we'll be more than happy to resend them, but I, I did get the confirmation that they all sent to you, so you should be OK.
[CUSTOMER][POSITIVE] OK. OK, perfect. Thank you very much. Have a wonderful day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that was all.
[AGENT][POSITIVE] Alright, well, thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.