AccountId: 011433970860
ContactId: 3cc83dc0-aaae-49fa-974b-871e0ebd21b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681799 ms
Total Talk Time (AGENT): 197414 ms
Total Talk Time (CUSTOMER): 180836 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/3cc83dc0-aaae-49fa-974b-871e0ebd21b3_20250204T15:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], myself [PII]. I'm calling from Nicholas Children's Hospital provider office. I'm looking for claiming status.
[AGENT][NEUTRAL] OK, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I didn't hear your name.
[CUSTOMER][NEUTRAL] [PII]. And your last initial name?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], may I have a good contact? Go ahead.
[CUSTOMER][NEUTRAL] M M
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the, well, how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 4 claims.
[AGENT][NEUTRAL] May I have the first member's policy number?
[CUSTOMER][NEUTRAL] 241-9368
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] [PII], range in [PII].
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Charges is $798.40.
[AGENT][NEUTRAL] OK, what did you say about the date? Was it arranged or you were just repeating yourself?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So [PII] and the amount of $798.48.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] Claim number is 3496591.
[CUSTOMER][NEUTRAL] Sorry, 349.
[AGENT][NEUTRAL] 659 1.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK, and process this.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Give me a call reference number.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, you can move on to the next member when you're ready.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Next member ID is uh
[CUSTOMER][NEUTRAL] 1984141.
[AGENT][NEUTRAL] 1984141?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Ma'am, my name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And charges $696.22.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would the provider be the same on this claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sure we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3486055.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. Give me address for explanation of the information.
[AGENT][NEUTRAL] You would like our address? OK, our address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I explain?
[AGENT][NEUTRAL] Um, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] 1419025
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Ma'am my name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And hold on, hold on, hold on one second. I'll move on to the next one. I'm ready. For the policy number, you said it was 1410925?
[CUSTOMER][NEUTRAL] Date of service is uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or 9025.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Policy number 1419025.
[AGENT][NEUTRAL] Thank you for that. And can you um give the date of birth again and the member's first and last name?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Date of birth is [PII]. My patient name is [PII]. Date of birth date of service, [PII].
[CUSTOMER][NEUTRAL] Charges $888.69.
[AGENT][NEUTRAL] So you received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 5458.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] That I think
[CUSTOMER][NEUTRAL] And I will next thing.
[AGENT][NEUTRAL] Um, hold on one moment. I have to know each policy. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Next member's policy number?
[CUSTOMER][NEUTRAL] My policy number is
[CUSTOMER][NEUTRAL] 02408940
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Date of [PII].
[AGENT][POSITIVE] Thank you again and
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you repeat the date of service, please?
[CUSTOMER][NEUTRAL] [PII]. Then in [PII] charges $3,881.46.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. There's no claim on file for [PII] for [PII] or just [PII] on file.
[CUSTOMER][NEUTRAL] Member is active date of service.
[AGENT][NEUTRAL] Yes, the policy has been active since [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And it turns
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you so much.