AccountId: 011433970860
ContactId: 31f3228f-e155-4fc7-9ce4-8fc1a042d80c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 914760 ms
Total Talk Time (AGENT): 245995 ms
Total Talk Time (CUSTOMER): 285312 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/31f3228f-e155-4fc7-9ce4-8fc1a042d80c_20250204T15:14_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, myself, [PII]. I'm calling from Nicholas Children's Hospital provider office. I'm looking for a claim status.
[AGENT][NEUTRAL] Can I have your name again? cause I didn't catch it when you stated it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it's like your phone is [PII]. Could you pronounce and spell your name again for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do apologize, but I'm not able to, uh, I'm not understanding you. It's like there's an [PII] a muffle.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Give me your name, please.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][NEUTRAL] The policy number of the member, yes.
[CUSTOMER][NEUTRAL] Could you repeat that, spell out, please?
[AGENT][NEUTRAL] The policy, my name or the policy number, the question that I asked?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Your name.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. My
[CUSTOMER][NEUTRAL] And NPI number is 187.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The policy number of the member that you're calling about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] 7544
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] What is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Ma'am my name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility or to check the status of a claim?
[CUSTOMER][NEUTRAL] Claim, Mr. uh.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So you're calling to check the status of the claim for [PII], and could you provide me with that bill amount and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] $6,244.61.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. We're requesting the primary EOB to be sent in because we are the gap insurance.
[CUSTOMER][NEUTRAL] OK. And claim number, please?
[AGENT][NEUTRAL] 348-578-0. That's 348578-0.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Just a moment. Could you repeat that? 34?
[AGENT][NEUTRAL] 85,780.
[AGENT][NEUTRAL] Is there anything else that I can assist you with, [PII]?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] No, uh, this claim is done, but I have 5 more claims, so please give me details.
[AGENT][NEUTRAL] For the same member or a different member?
[CUSTOMER][NEUTRAL] Member is different provider the same.
[CUSTOMER][NEUTRAL] And give me call reference number.
[AGENT][NEUTRAL] We don't provide those.
[AGENT][NEUTRAL] You can use my name in today's date as a reference. What's your next policy number?
[CUSTOMER][NEUTRAL] Next policy number is um
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] 531-84
[AGENT][NEUTRAL] What is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Could you repeat the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you're calling to check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] Date of service is uh [PII], range is [PII].
[CUSTOMER][NEUTRAL] Charges $705.72.
[AGENT][NEUTRAL] 261.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim because we're requesting the primary EOB to be sent in.
[CUSTOMER][NEUTRAL] Mhm. Claim number?
[AGENT][NEUTRAL] 3452061
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is your next policy number?
[CUSTOMER][NEUTRAL] Next policy number is 0214.
[CUSTOMER][NEUTRAL] 124
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] What is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Date of service is uh [PII], [PII].
[CUSTOMER][NEUTRAL] Sorry. Charges is 22,900.
[AGENT][NEUTRAL] What is your bill amount?
[CUSTOMER][NEUTRAL] Yeah, $22,928.05.
[AGENT][NEUTRAL] Give me that date of service one more time.
[CUSTOMER][NEUTRAL] [PII], range in [PII].
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][NEUTRAL] $22,928.05.
[AGENT][NEUTRAL] I'm not showing a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Member is active on date of service or not?
[AGENT][NEUTRAL] Yes, the member's policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I move next claim?
[AGENT][NEUTRAL] Could you give me a moment? I have to make notations on the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is your next policy number?
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 023.
[CUSTOMER][NEUTRAL] 530
[CUSTOMER][NEUTRAL] 97
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. I got it.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Date of service is [PII], sorry, [PII], but in [PII].
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] Minimum
[CUSTOMER][NEUTRAL] $10,795.
[CUSTOMER][NEUTRAL] 23 cents.
[AGENT][NEUTRAL] Not showing the claim on file for the data service.
[CUSTOMER][NEUTRAL] Member is active.
[AGENT][NEUTRAL] The member has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your next policy number?
[CUSTOMER][NEUTRAL] Next policy number is 0170322.
[AGENT][NEUTRAL] So I'm missing some numbers. Could you repeat that policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 01770322.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. And date of birth is [PII].
[CUSTOMER][NEUTRAL] Charges is, so date of service is [PII].
[CUSTOMER][NEUTRAL] Charges $690.28.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim, and the reason why is because we're requesting the EOB for the primary to be sent in. Are you guys aware that this these policies here at American Public Life is gap insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Because none of your clients have the EOB we're requesting the EOB for all the claims that you've checked status for that we do have in the system.
[CUSTOMER][NEUTRAL] Yes, uh
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Yeah, don't know. APL is uh
[CUSTOMER][NEUTRAL] Give me claim number, please.
[AGENT][NEUTRAL] It is 34, I'm sorry, 354-7012.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] 0184.
[AGENT][NEUTRAL] Could you give me a moment because I'm not ready for the policy number.
[CUSTOMER][NEUTRAL] 3884
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Because you can provide me with the policy number now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 01843884.
[AGENT][NEUTRAL] What is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Date of service of [PII].
[AGENT][NEUTRAL] Could you slow down, please? Could you, could you please slow down and verify the date of birth for [PII] again, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] No [PII] charges $2,933.64.
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII]. There was no payment made on this claim because we're requesting the EOB to be sent in.
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] 3541958
[CUSTOMER][NEUTRAL] 341 9
[AGENT][NEUTRAL] No, 3541958.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. Are we done with your claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.