AccountId: 011433970860
ContactId: 18f28f37-1f52-473c-939c-1cc1663225cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 585700 ms
Total Talk Time (AGENT): 166483 ms
Total Talk Time (CUSTOMER): 118453 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/18f28f37-1f52-473c-939c-1cc1663225cc_20250403T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling the provider's office and I'm here for a claim status.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, can I get your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The first name is uh [PII], the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth for the member is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Member ID number is 1565938 letter M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and uh the date of birth was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Uh, date of birth was, just a second, please.
[AGENT][NEUTRAL] Yes sir, and it was [PII]
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The data service is uh
[CUSTOMER][NEUTRAL] [PII] bill amount $1,359.27.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, see, the total charges were 13,000.
[CUSTOMER][NEUTRAL] I'm sorry, $1,359.27 only.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you must have received something for $974.
[AGENT][NEUTRAL] OK and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up this claim for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for holding for me, [PII]. So I was looking for the claim, um, the policy number that you gave me to begin with is no longer active. Let me give you the um insured's good policy number.
[AGENT][NEUTRAL] It's 221-411-0.
[AGENT][NEUTRAL] And looking on data service of [PII], I do not find a claim under Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Are you sure because my system shows it's being denied. Uh, unfortunately, I don't, don't have the claim number with me. So just keen to know if uh if this was.
[AGENT][NEUTRAL] I do have a claim, but it's not for that provider, so I can't give information out.
[CUSTOMER][POSITIVE] Really the case.
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Let me check some time.
[CUSTOMER][NEUTRAL] All right. Uh, do you have the claim under NPI 1760756225?
[AGENT][NEUTRAL] My
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] It's for Miramar Outpatient center.
[AGENT][NEUTRAL] Yes, it's for Miramar Outpatient Center, yes sir, that's where I found the claim under, uh, let me.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And it's asking to please provide copies of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right, what's the team number?
[AGENT][NEUTRAL] It is 352.
[AGENT][NEUTRAL] 1988.
[CUSTOMER][NEUTRAL] 1 I need it. And and uh when was this processed?
[AGENT][NEUTRAL] 3521988.
[CUSTOMER][NEUTRAL] No, no, I was asking the processed date.
[AGENT][POSITIVE] Oh sorry about that. Let me look that up for you real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] We received it on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] All right, can you please provide me the mailing address and the fax number to which we need to send the payment to the EIB.
[AGENT][NEUTRAL] Yes, um, the fax number is [PII].
[AGENT][NEUTRAL] And then the mailing address is [PII] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that I'm sorry [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, I'm here. Did you get the zip code? [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] All right. Caller this number, please?
[AGENT][NEUTRAL] You can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much for your time, [PII]. Have a great day.
[AGENT][POSITIVE] You too, [PII] thank you for calling APL you have a wonderful day. Anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] That's all for today.
[AGENT][POSITIVE] OK, well you take care and thanks for calling APL bye bye sir.
[CUSTOMER][NEUTRAL] Bye-bye