AccountId: 011433970860
ContactId: 46924b4d-bd58-46eb-a890-992d15775b3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592989 ms
Total Talk Time (AGENT): 208189 ms
Total Talk Time (CUSTOMER): 117927 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/46924b4d-bd58-46eb-a890-992d15775b3e_20250212T14:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital, and I'm trying to check a couple claim statuses, please.
[AGENT][NEUTRAL] I can verify claim status. [PII]. May I have a policy number?
[CUSTOMER][NEUTRAL] Um, yes, for the first one it is 02451617 M for Mike, L for Larry, number 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], last name is spelled [PII]
[CUSTOMER][NEUTRAL] Uh, that date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] And total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount is $4,748.99.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII]. Check claim status as well. One moment.
[AGENT][NEUTRAL] Looks like this processed under claim number 3513076, and we are asking for the primary insurance explanation of benefits.
[AGENT][NEUTRAL] This claim
[CUSTOMER][NEUTRAL] OK. It looks
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, you're fine. Go ahead.
[CUSTOMER][NEUTRAL] Um, it looks like on December, let's see, [PII], that was that, uh, ELB was faxed over.
[AGENT][NEUTRAL] OK, let me go back up.
[AGENT][NEUTRAL] I do apologize, the system is slow.
[AGENT][NEUTRAL] OK, it looks like this is a different provider, but we never received that EOB. Can you verify the fax number?
[CUSTOMER][NEUTRAL] Uh, it looks like they sent that to [PII].
[AGENT][NEUTRAL] And that is correct, but I'm not showing we received it. Let me make sure it's not under anything else.
[AGENT][NEUTRAL] And I don't show it under.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Anything else under this family. There's no other policy. So if you don't mind refaxing it, not sure what.
[AGENT][NEUTRAL] Happen with that, but.
[CUSTOMER][NEUTRAL] And that needs to be attention, uh, claims department rep.
[AGENT][NEUTRAL] Claim
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Send that back over today.
[AGENT][NEUTRAL] Yeah, I'm not showing it being received there's nothing open or outstanding on this file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, I'm not member. I do have a different member, uh, same tax ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] I'm ready when you are.
[CUSTOMER][NEUTRAL] OK. Uh, that number ID is 017.
[CUSTOMER][NEUTRAL] 80474 [PII] for [PII]
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just pulled up.
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] 421 24.
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] $4,765.78
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, this looks like an ER visit. It processed under policy number 02252792.
[AGENT][NEUTRAL] And it looks like it processed under claim number.
[AGENT][NEUTRAL] 3,461,070 in which we ask for the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and it does look like on [PII] that was the primary ELB was faxed, um, have you all did you all receive that?
[AGENT][NEUTRAL] OK, let me look I'm saying 2.
[AGENT][NEUTRAL] More claim numbers for this same data service, let me get that pulled up.
[AGENT][NEGATIVE] Look like they both were denied as well.
[AGENT][NEUTRAL] For the major medical explanation of benefits.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] This one was received.
[AGENT][NEUTRAL] In August.
[AGENT][NEUTRAL] OK, it looks like this was 58 pages from Nicholas Children's Hospital.
[AGENT][NEUTRAL] Let me see what the other one is.
[AGENT][NEGATIVE] So this one was submitted on [PII] and it does not have the EOB attached.
[AGENT][NEUTRAL] And then the previous one, I'm going through this one is 58 pages. It looks like the medical notes from the ER.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Just looking for the.
[AGENT][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] And this one only shows the
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] Information from the hospital, the discharge, the admit, the notes.
[AGENT][NEUTRAL] There's no it'll be in that one either.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I will send that one over again as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we have the actual um billing, we would just need the ELB. You don't have to resend that again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, do you have a reference number for our call today?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, and I thank you so much for your help today.
[AGENT][POSITIVE] [PII], you're so welcome, and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You too. Thank you.