AccountId: 011433970860
ContactId: 2ef8fbac-f505-445e-9be1-1835f495d6d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346029 ms
Total Talk Time (AGENT): 104696 ms
Total Talk Time (CUSTOMER): 141508 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/2ef8fbac-f505-445e-9be1-1835f495d6d1_20250624T14:30_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII], and I'm calling from Nicholas Children's Hospital and looking for uh claim status for a patient.
[AGENT][NEUTRAL] Sure, I can assist you with that, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah, the callback number will be [PII].
[CUSTOMER][NEUTRAL] And the policy number will be 02465765ML8.
[AGENT][NEUTRAL] Could you repeat that callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is that member's name and date of birth that you're calling about today, [PII]?
[CUSTOMER][NEUTRAL] The member name is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The date of birth for [PII] will be just give me a second, it will be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling to check the status of a claim, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the date of service now?
[CUSTOMER][NEUTRAL] The date of service is actually there are two dates of service for this patient and the first one is [PII].
[AGENT][NEUTRAL] I can only look at one at a time. What's the first one?
[CUSTOMER][NEUTRAL] Yeah, the first one is [PII] and the total bill amount on the claim is.
[CUSTOMER][NEUTRAL] $1200.43.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 7782.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. [PII], there was no payment made on this claim, and the reason why there was no payment?
[AGENT][NEUTRAL] Is because the benefits are payable only if the primary make a payment, so um.
[AGENT][NEUTRAL] Pulling up the policy, the claim itself to verify if you guys sent in the ELB and see if the primary made a payment towards it.
[CUSTOMER][NEUTRAL] OK, so the
[AGENT][NEUTRAL] So bear with me.
[CUSTOMER][POSITIVE] Primary actually had a, OK.
[AGENT][NEUTRAL] So it doesn't look like the primary put anything towards deductible, co-pay, or co-insurance. So do you have an updated detailed ELB?
[CUSTOMER][NEUTRAL] Yeah, actually we have submitted the EOB which has a deductible of $313.61.
[AGENT][NEUTRAL] You submitted that ELB we haven't received it.
[AGENT][NEUTRAL] When did you submit it?
[CUSTOMER][NEUTRAL] OK, actually we have software.
[CUSTOMER][NEUTRAL] It was submitted on [PII] along with a claim.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that I'm not showing a claim for that we received the [PII]. The only one that I'm seeing is the one that I'm mentioning in the EOB that we do have has no amount towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, we will resubmit it again. Can you provide me the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 35 I'm 3597782.
[CUSTOMER][NEUTRAL] Just allow me a second.
[CUSTOMER][NEUTRAL] 359-778-2.
[CUSTOMER][NEUTRAL] OK, there is one thing which I need to ask you for this claim that uh when I'm checking this claim on the claim number which you have provided to me on your provider portal, so it is showing that the claim not found. I don't understand why.
[AGENT][NEUTRAL] What is it asking you for? Are you putting in the correct information?
[CUSTOMER][NEUTRAL] Uh, I, I'm putting the claim number, the first name of the patient, and the date of birth of the patient.
[AGENT][NEUTRAL] The claim number is 359-7782. That's 3597782.
[CUSTOMER][NEUTRAL] And it is stating that claim not.
[CUSTOMER][NEUTRAL] 7782. Yeah.
[AGENT][NEUTRAL] Is it asking for the patient account number?
[CUSTOMER][NEGATIVE] But it is not showing
[CUSTOMER][NEUTRAL] No, it is not asking for only the 3 details it is asking for, which is, which is like.
[CUSTOMER][NEUTRAL] Claim number, first name of the patient, and the date of birth.
[AGENT][NEUTRAL] And it's not requesting an account number.
[AGENT][NEUTRAL] Do you have the correct date of birth?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, it is [PII] if I'm correct. That is what I provided to you also.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, just let me check. Uh, OK.
[CUSTOMER][POSITIVE] No issues. I will look into this uh that that will help me to download the. That is why I'm checking it on the portal. No worries.
[CUSTOMER][NEUTRAL] OK then there is one more date of service can you check for that too?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the next date of service?