AccountId: 011433970860
ContactId: 06738279-29f7-4dd7-addc-186e4fa0d403
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415910 ms
Total Talk Time (AGENT): 106340 ms
Total Talk Time (CUSTOMER): 131484 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/06738279-29f7-4dd7-addc-186e4fa0d403_20250619T15:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, [PII]. My name is [PII]. I'm calling from Nicholas Children's Hospital following up on a claim.
[AGENT][POSITIVE] Yeah, I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number with you?
[CUSTOMER][NEUTRAL] 02474464 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII], [PII]. I have the claim number as well if you need it.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, and what is the claim number?
[CUSTOMER][NEUTRAL] Um, that is 3583218.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] Looks like this claim.
[CUSTOMER][NEUTRAL] It would
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEGATIVE] It was missing the primary EOB. Yeah, we it was missing the primary EOB and we went ahead and mailed it to you guys on [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me check and see.
[AGENT][NEUTRAL] And the date of service was um
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] [PII]. Correct, yeah, for $21,311.26.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me check here real quick.
[AGENT][NEUTRAL] OK, it looks like the wrong EOB was sent in because it says uh.
[AGENT][NEUTRAL] The receipt of a reference claim is acknowledged, however, in order for us to process the claim, we need an explanation of benefit that matches the claim information.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Submitted the primary EOP that we received and that one specifically says that there is a patient responsibility of $5,219.02.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That is specified on the EOB so I don't understand.
[CUSTOMER][NEUTRAL] And that was for the deductible and co-insurance on the last page stays the reason for the patient responsibility.
[CUSTOMER][NEUTRAL] And I'm, I'm looking at the documentation that was sent.
[AGENT][NEUTRAL] OK, give me just one moment, let me see if I can get someone from our claims department to look into this, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] from the APL care team.
[AGENT][NEUTRAL] I have a provider on the line for Nicholas Children's Hospital for policy number 2474464 uh part two [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have the claim number as well, uh, whenever you're ready.
[CUSTOMER][NEUTRAL] OK, what's the claim number?
[AGENT][NEUTRAL] 361-053-5
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she was wondering if you could help uh help her understand why.
[AGENT][NEUTRAL] It, it, the claim remarks says that the EOB doesn't match the the medical claim, and she's stating that it is. I'm unable to read it. Um, can I transfer her over to you?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment and I'll introduce you.
[AGENT][POSITIVE] Hi, [PII], I have [PII] from claim support on the line. She's gonna be able to help you with that.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How are you?
[CUSTOMER][NEUTRAL] Hi [PII] good um good morning. This is [PII] calling from Nicholas Children's Hospital. OK.
[CUSTOMER][NEUTRAL] Um, I was calling in regards to a claim. Um, [PII] was telling me that the EOB did not, was not appropriate, or, but I'm looking at the documentation that we sent and it it the EOB that we sent actually says that it was a patient responsibility of 5,21902 and and the last page indicates that it was the for deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, can you give me just a second to uh pull up the rest of your information and look at it. One second. Thank you, thank you.