AccountId: 011433970860
ContactId: 169af055-7115-4036-b04c-b6eb4dfec74f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472750 ms
Total Talk Time (AGENT): 219891 ms
Total Talk Time (CUSTOMER): 127859 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/169af055-7115-4036-b04c-b6eb4dfec74f_20250506T20:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling just to get um an email address where I can send my EOB that's pending um within my claim.
[AGENT][NEUTRAL] OK, so you're wanting to Miss [PII], you're wanting to find out how to submit your primary or your explanation of benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, it's, it's to submit my explanation of benefits. Mhm.
[AGENT][POSITIVE] Yes, ma'am, I can help you
[AGENT][NEUTRAL] Yes, no, I can help you with that, but first I'll have to pull up your policy information and verify some things with you for security. So first off, what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] 01813054
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and so first off, Miss [PII], any information provided would be a verification of benefits and not a guarantee of payment. So if you could please verify the policy holder's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we would have on file for Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Alright, so that's all of the information that I need to verify. So you have an explan is this claim for yourself, Miss [PII]?
[CUSTOMER][NEUTRAL] The claim was submitted by the hospital in Nicholas Children's Hospital for my daughter, um, [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] OK, all right, so just one moment please.
[CUSTOMER][NEGATIVE] So apparently it was denied because it was missing some information, so that's why I need to send the explanation of benefits showing the whole um the whole total.
[AGENT][NEUTRAL] OK, and what did you say your daughter's first name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, so one moment.
[AGENT][NEUTRAL] OK, what's, OK.
[AGENT][NEUTRAL] OK, so because
[AGENT][NEUTRAL] This policy is no longer active. OK, so first off, we cannot accept claims information, Miss [PII] via email, but I can give you our secured fax line where it can be faxed.
[CUSTOMER][POSITIVE] OK, yeah, that, that would be great. Um.
[AGENT][POSITIVE] OK. So just let me know when you're ready and I'll be happy to give you that number.
[CUSTOMER][NEUTRAL] What is that number?
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 23 attention claims department.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Is that you'll be the only thing that's pending for um for them to process this claim?
[AGENT][NEUTRAL] And you said the date of service is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me double check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so yes, ma'am. According to the remarks on the claim, the explanation of benefits that we received did not, it was not detailed. It didn't show the amounts that have been applied to the deductible, co-pay or co-insurance. So the remarks do state that we have, this is what the remarks read. We have received a primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I wonder, I wonder if you got if you received the same one I, I received.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, I don't know how to tell.
[AGENT][NEUTRAL] So on there, it does have categories for co-pays, deductibles, or co-insurance.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And if it doesn't have those listed out, then we would have to have one that does.
[CUSTOMER][NEUTRAL] OK. I see co-pay, coinsurance, um,
[CUSTOMER][NEUTRAL] Apply to deductible amounts paid by your plan, savings and plan.
[CUSTOMER][POSITIVE] So I believe this is, this should be the correct one.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I got this one from the insurance itself from my primary.
[AGENT][NEUTRAL] OK. So what I would do is, yes, ma'am, I would recommend definitely going ahead and faxing that if it does show those um categories and the amounts in those categories.
[AGENT][NEUTRAL] Or one of them. Um, if it has, you know, dollar amounts in one of those three categories, then yes, ma'am.
[AGENT][NEUTRAL] I would submit that. I can say.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me just see if I can see what we received.
[AGENT][NEUTRAL] It's gonna take a moment to load this for me, Miss [PII]. Just a moment.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So yes ma'am, what we received did not have those amounts. So if what you have does show amounts in one of those three categories, then yes ma'am, fax that to that fax number that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you said co-pay, co-insurance, or which other one?
[AGENT][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] Deductible. Oh, that one I don't have a.
[CUSTOMER][NEUTRAL] A column for my.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Right. Then they may not have something in all three, but what we received didn't have those categories broken out.
[CUSTOMER][POSITIVE] OK. All right. Great. So I'll go ahead and fax this over, hopefully um get that cleaning processed already. Thank you so much for your help.
[AGENT][POSITIVE] Well, you're certainly very welcome. And is there anything else that I could help you with this afternoon?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a very nice evening.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Right.