AccountId: 011433970860
ContactId: 2a144cdb-05d2-4438-a4f9-5657235fccc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343559 ms
Total Talk Time (AGENT): 107880 ms
Total Talk Time (CUSTOMER): 69667 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/2025/04/24/2a144cdb-05d2-4438-a4f9-5657235fccc5_20250424T17:47_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] Yeah, hi, [PII]. My name is [PII] and I'm calling on behalf of provider office and looking for a claim status.
[AGENT][NEUTRAL] OK, what is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Spell your name for me, please.
[CUSTOMER][NEUTRAL] [PII]. I'm [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. And you have one patient to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I have one only one patient, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 01843877 ML 7.
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up, please.
[AGENT][NEUTRAL] And any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service, [PII]. And the total charge is $519.19.
[AGENT][NEUTRAL] 519.19. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the name of the provider facility?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, give me just a moment to look at something please.
[AGENT][NEUTRAL] OK, and again, you said that the bill amount is going to be 519.19. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on this claim it was.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] 355-88889.
[CUSTOMER][NEUTRAL] 35588889.
[AGENT][NEUTRAL] And, mhm.
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][NEUTRAL] Correct, ma'am?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied, and the reason for the denial is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] OK. Uh, may I know the received date? Received one?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] 131 2025, processed on [PII].
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 3, 2025.
[CUSTOMER][NEUTRAL] OK, may I know the reference number?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] Yes, so you would use my name that I gave you along with today's date, and [PII], if you need a copy of this explanation of benefits, you may print that directly from our portal now that you have the claim number by going to [PII].
[CUSTOMER][NEUTRAL] Yeah, uh T R Y C A. Correct? Triy.
[AGENT][NEUTRAL] T R A C I.
[CUSTOMER][NEUTRAL] T R A C I.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you. Thank you. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome. And can I, uh, you too. Can I help you with?
[CUSTOMER][NEUTRAL] And the reference number is your name?
[CUSTOMER][NEUTRAL] Your name is.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Correct, ma'am?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Bye, bye.
[AGENT][NEUTRAL] My name in today's date would be your call reference number.
[CUSTOMER][POSITIVE] Thank you bye bye