AccountId: 011433970860
ContactId: 3e722045-300f-4b85-97f6-6cfb53766cc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600710 ms
Total Talk Time (AGENT): 198297 ms
Total Talk Time (CUSTOMER): 101051 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/3e722045-300f-4b85-97f6-6cfb53766cc1_20250116T18:50_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Can you please help me with the claim?
[AGENT][POSITIVE] Yeah, I'd love to help you with claim status today, [PII], um, and what is a good call back number I can get for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you and your member's policy number?
[CUSTOMER][NEUTRAL] 02473
[CUSTOMER][NEUTRAL] 48
[CUSTOMER][NEUTRAL] 4, M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. Let me get that pulled up for you.
[AGENT][NEUTRAL] Perfect. And can you verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name [PII].
[CUSTOMER][NEUTRAL] And the date of birth, [PII].
[AGENT][NEUTRAL] Alright, let me just make sure I have this policy right. Uh, you said 2073484?
[CUSTOMER][NEUTRAL] No, no. It is 024.
[CUSTOMER][NEUTRAL] 734.
[CUSTOMER][NEUTRAL] 84.
[AGENT][POSITIVE] OK, I'm so sorry. I don't know how I got that wrong. Let me try again.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] You said for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that date of birth one more time if you can, please.
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][POSITIVE] Thank you so much and
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] What is the date of service on the claim we wanna look at for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect and the build them out?
[CUSTOMER][NEUTRAL] Total bill amount is
[CUSTOMER][NEUTRAL] $1,364.15.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And it was submitted on [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, and I am seeing that here I believe, would you be able to verify for me the name of the facility on file?
[CUSTOMER][NEUTRAL] Sure. It is Nicholas Children's Hospital.
[AGENT][NEUTRAL] It wouldn't have a different
[AGENT][NEUTRAL] Facility or provider name on it?
[CUSTOMER][NEUTRAL] It is also known as West Outpatient Center.
[AGENT][POSITIVE] OK, perfect. I do have it under West Bird, thank you. One second, let me go back.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Alright, I do have your claim here. It looks like we received your claim on our side, [PII]. We processed it [PII]. I have your claim number listed as 3507942.
[AGENT][NEUTRAL] And I do show that the claim did deny. I have the the reason stating um benefits are only payable if your major medical insurance provides benefits. Um, if this claim is later paid by your major medical insurance, please send an explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please verify the mailing address and uh uh payer ID.
[AGENT][NEUTRAL] Um, yeah, our payer ID is 60801, and our mailing address here is [PII]. That is in [PII] City, [PII].
[AGENT][NEUTRAL] Our zip code here is [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] Yeah my pleasure. Is there anything else I can do to help you out today?
[CUSTOMER][NEUTRAL] Uh yes, I have one more claim.
[AGENT][NEUTRAL] One more claim, OK. Is it for the same insured or a different insured?
[CUSTOMER][NEUTRAL] It is a different one.
[AGENT][POSITIVE] OK perfect let me get these notes put in on this one and I'll be able to help you with that next one, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right. Thank you for your patience. And what is that next policy number we want to look at today?
[CUSTOMER][NEUTRAL] It is 0199.
[CUSTOMER][NEUTRAL] 1392.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Perfect and
[AGENT][NEUTRAL] The date of service for this one?
[CUSTOMER][NEUTRAL] The services.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It is for [PII].
[AGENT][POSITIVE] Perfect. Hang tight one second.
[AGENT][NEUTRAL] And would you be able to verify for me your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And name [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] And that total bill amount?
[CUSTOMER][NEUTRAL] $2,822.88.
[AGENT][NEUTRAL] it sounds.
[AGENT][POSITIVE] Perfect. One second, [PII].
[CUSTOMER][NEUTRAL] And it was submitted on
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright. Hang tight with me one more second.
[AGENT][NEUTRAL] All right. I believe this is it, um.
[AGENT][NEUTRAL] OK, I see that we received your claim on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It looks like we processed that claim on [PII].
[AGENT][NEUTRAL] I have your claim number listed as 3452056 and I do show that claim was denied. Um, it is requesting an explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. Uh, could you please repeat the claim number 345?
[AGENT][NEUTRAL] Yes, sorry, 3452056.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Thank you for your help.
[AGENT][POSITIVE] Yeah, absolutely. Anything else I can do to help you out, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Yeah, my pleasure. Well you thanks for calling APL and I hope you have a fabulous day.