AccountId: 011433970860
ContactId: 4cf0e8be-f9f0-48ab-9876-6147005fa11e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1521479 ms
Total Talk Time (AGENT): 219428 ms
Total Talk Time (CUSTOMER): 559569 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/4cf0e8be-f9f0-48ab-9876-6147005fa11e_20250116T19:49_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Your name is [PII]?
[AGENT][NEUTRAL] My name is [PII]. Uh-huh.
[CUSTOMER][NEUTRAL] Oh, hi [PII]. My name is [PII] I M.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Calling from Nicholas Sins Pediatrics.
[CUSTOMER][NEUTRAL] I'm here for claim status.
[AGENT][POSITIVE] All right, I'm happy to check a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] 016.
[CUSTOMER][NEUTRAL] 99646.
[CUSTOMER][NEUTRAL] And firstly my call callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Sorry, patience?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][POSITIVE] Built out.
[CUSTOMER][NEUTRAL] 245.28 cents.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I'm not showing any claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Yes, you didn't find that claim?
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEGATIVE] Actually we had a call in just between 2 months ago and also they just provided me all the claim status on call and also I just suggested for uh sign in UOB through fax but you just said claim is not on file.
[AGENT][NEUTRAL] Correct, I don't see one. Do you have a claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, 352.
[CUSTOMER][NEUTRAL] 4388.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So you received that link?
[AGENT][NEUTRAL] Yeah, so the patient has a different policy number that is active. Would you like to take that down so you have it?
[CUSTOMER][NEUTRAL] Uh, no, just actually I just need, uh, UB from you.
[CUSTOMER][NEGATIVE] I have the claim status that received on [PII] is denied on [PII], and it is denied for office visit not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Claim number 352-438-8.
[AGENT][NEUTRAL] A benefit amount was sent in the amount of $284.09.
[CUSTOMER][NEUTRAL] Could you please repeat the claim status?
[CUSTOMER][NEUTRAL] maybe.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK. OK. [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $284.09.
[CUSTOMER][NEUTRAL] It was benefit. Can you please repeat it to us?
[AGENT][NEUTRAL] A payment was sent.
[CUSTOMER][POSITIVE] It was benefit, benefit payment.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Could you please repeat hold line?
[AGENT][NEUTRAL] The benefit payment was sent in the amount of $284.09.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was a single check issued [PII] check number.
[CUSTOMER][NEUTRAL] Check issued on 1024.
[AGENT][NEUTRAL] 103124.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Check number is 201.
[AGENT][NEUTRAL] 1358.
[CUSTOMER][NEUTRAL] 201.
[CUSTOMER][NEUTRAL] Sorry, 201?
[AGENT][NEUTRAL] 1358.
[CUSTOMER][NEUTRAL] 1358. OK.
[AGENT][NEUTRAL] What is the fax number you'd like this sent to?
[CUSTOMER][NEUTRAL] Yes, 531 513.
[CUSTOMER][NEUTRAL] 964
[CUSTOMER][NEUTRAL] 624-7. Uh, is there any other way to get that, uh, you be in a faster way?
[AGENT][POSITIVE] That would be the quickest way to send it to you.
[CUSTOMER][NEUTRAL] OK, OK, OK, because, uh, I'm just call, I am just calling you 3rd time actually for this insurance, but I didn't get that EV. That's why I'm just asking you.
[AGENT][NEUTRAL] OK, I'm sending it now. Just give me a moment, please.
[CUSTOMER][NEUTRAL] I need to.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And just to confirm, the fax number was [PII].
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. EUB has been sent, so it should be there within 5 minutes.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] So, uh, could you please provide me the details about the claim that, uh, I can see here there is a, uh, $35 amount is remaining here.
[CUSTOMER][NEUTRAL] Is it under the patient's plan, uh, patient's responsibility, or is there any denial for this amount?
[AGENT][NEUTRAL] It was the max benefit payable for the state of service, so the max benefit was met for that date. There's nothing additional payable.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Max benefit. OK, Max benefit me, OK.
[AGENT][NEUTRAL] As far as patient responsibility that's up to the facility or provider we're not able to advise.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, there is no patient responsibility?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK. So this is not related to office visit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, OK OK.
[CUSTOMER][NEUTRAL] Uh, what is the uh call reference number right after I have more accounts for you.
[AGENT][NEUTRAL] That's going to be my name with my last initial in today's date. The last initial to my name is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, moving to the next account.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I will definitely be on my name.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Next policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, next member's ID is.
[CUSTOMER][NEUTRAL] 020
[CUSTOMER][NEUTRAL] 420
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] They
[AGENT][POSITIVE] Alright, thank you for that data service.
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is 245.28 cents.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And claim number is
[CUSTOMER][NEUTRAL] 346559-3
[CUSTOMER][NEUTRAL] Oh you can download the
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so this claim was received, it was denied office visits are not covered under the member plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, is it received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, OK, OK. Uh, so, so just I need UV.
[AGENT][NEUTRAL] OK, let me send that to you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] I like my.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK. EOB is being sent, should be there within the next few moments.
[CUSTOMER][NEUTRAL] OK, if I will not get the UV, uh, so next time you can send it to me through my email address. Do you have access for that?
[AGENT][NEUTRAL] Uh, we're not able to send through email. It's not secure. We can only send through fax.
[CUSTOMER][POSITIVE] OK, OK, OK. Definitely. Moving to the next time.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, next policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 859 8.
[CUSTOMER][NEUTRAL] 8 M as in Mike. L as in Lima 8.
[CUSTOMER][NEUTRAL] uh
[AGENT][NEUTRAL] Name of the patient, date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Date of service is
[CUSTOMER][NEUTRAL] [PII] bill amount is 544.92 cents.
[CUSTOMER][NEUTRAL] Claim number is 3465209.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Claim was received [PII], denied on [PII]. The office visits are not covered.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Yeah, definitely. So please send that to you.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I got it got it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] Thank you so much
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] EOB is on its way.
[CUSTOMER][NEUTRAL] OK. Moving to the next one.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] 014.
[CUSTOMER][NEUTRAL] 9141.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the uh patient name and date of birth please?
[CUSTOMER][NEUTRAL] N is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] What was the first name?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII] bill amount is 480.
[CUSTOMER][NEUTRAL] 46 cents. Just I need EUB.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, EOB is on its way for that one.
[CUSTOMER][NEUTRAL] OK, moving to the next account.
[AGENT][NEUTRAL] Let me just finish my notes here. One moment.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, allow.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Next policy number?
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yes, next policy is 022.
[CUSTOMER][NEUTRAL] 165
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] M Mike L Lisa Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII] bill amount is 354.42 cents. Just I need EOB.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You a lot of money for this service that we don't do something else.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Did you make.
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] So so I can drink a beer.
[AGENT][NEUTRAL] OK. EOB is on its way for that one.
[CUSTOMER][NEUTRAL] Moving to the next one.
[AGENT][NEUTRAL] Whenever you're ready.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Member's ID is 023.
[CUSTOMER][NEUTRAL] 1303.
[CUSTOMER][NEUTRAL] 9 M. [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] The amount is 354.42 cents and need you will be for this one again.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, EOB has been sent for that one.
[CUSTOMER][NEUTRAL] Uh, so I have another claim, uh, with the same member ID. The date of service is different.
[AGENT][NEUTRAL] And what's the data service?
[CUSTOMER][NEUTRAL] [PII] bill amount is 354. 42 cents.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Fax has been sent for that one.
[CUSTOMER][POSITIVE] OK, OK. Thank you so much. Complete your account.
[AGENT][NEUTRAL] You have another one?
[CUSTOMER][POSITIVE] No, no. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Thank you so much. You do have a great day.