AccountId: 011433970860
ContactId: 13f92a7e-cc1c-4f1f-9fd9-47e7dab14328
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 715340 ms
Total Talk Time (AGENT): 239084 ms
Total Talk Time (CUSTOMER): 117124 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/13f92a7e-cc1c-4f1f-9fd9-47e7dab14328_20250210T18:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital, um, to check a couple of claim statuses, please.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and you said that you have 2 claims to check status on, is that correct?
[CUSTOMER][NEUTRAL] Um, 2 for a status and then I do have a third one, but it's just to see if the EOB we submitted has been received.
[AGENT][NEUTRAL] OK. And is this for the same patient or different patients?
[CUSTOMER][NEUTRAL] Different patient but same facility.
[AGENT][NEUTRAL] OK, so you have 3 different, I just wanna make sure 3 different patients.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, yes ma'am I can help you with all of those. So [PII], just a few things um in advance you will use my name along with today's date as your call reference number for each. Also any information that I provide for you will be a verification of benefits and not a guarantee of payment. And then if we do have the claims on file and you need a copy of the EOB from ATL, you can actually print them directly from our portal by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] 02500540.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] [PII] and the total bill is $4,261.72.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3549005.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $600.
[AGENT][NEUTRAL] And that was paid on single check 202.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1924.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, and what was the payment date on that? Does it show you?
[AGENT][NEUTRAL] The payment the issue date was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did give you the claim number, didn't I?
[AGENT][NEUTRAL] [PII]. OK. OK.
[CUSTOMER][POSITIVE] Yes, you did, thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And is there anything else that you need on this number?
[CUSTOMER][NEUTRAL] Um, no, I think that's it on that one.
[AGENT][NEUTRAL] All right. So give me just one moment and we'll do your next one. Cause you said it was for a different patient, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Um, 243-072-5.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth on this policy.
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him.
[CUSTOMER][NEUTRAL] OK. It's [PII] 24 and $1,264.12.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that this claim was received.
[AGENT][NEUTRAL] The received date on it is going to be.
[AGENT][NEUTRAL] [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 1821.
[AGENT][NEUTRAL] And the reason for the denial on this one, [PII], is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do have the fax number and everything for that, so I'll get that faxed over after our call.
[AGENT][NEUTRAL] OK. So do you need any other information on this claim?
[CUSTOMER][NEUTRAL] No, that one's it as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and the next policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 0237
[CUSTOMER][NEUTRAL] 2885 M for Mike L for Lima 8
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK, and your patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the data service and total bill amount for her.
[CUSTOMER][NEUTRAL] OK, 52 of 24 through 53 of 24.
[CUSTOMER][NEUTRAL] And it's $3180.64.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so yes, we have received that EOB. It was received [PII].
[AGENT][NEUTRAL] Process the same date.
[AGENT][NEUTRAL] The claim number is going to be 3558153.
[AGENT][NEUTRAL] Um, there was a benefit paid.
[AGENT][NEUTRAL] In the amount of $1880.70.
[AGENT][NEUTRAL] And that was paid on single check 202-5595.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that was paid on the [PII] as well.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] And I think that is all.
[AGENT][NEUTRAL] And it states, oh, I'm sorry, oh I was just gonna read you with that payment on that particular claim on this claim, it states with this check the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I thank you very much for your help today.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all I can help you with, and thank you again, [PII], for calling APL and I hope that you have a great afternoon.
[CUSTOMER][POSITIVE] I hope you do too. Thank you so much.
[AGENT][POSITIVE] Yes, sir. You're welcome and thank you again for calling.
[CUSTOMER][NEUTRAL] Mhm. Bye bye.
[AGENT][NEUTRAL] Bye.