AccountId: 011433970860
ContactId: 4e30d8ea-b0fc-48f8-adc7-53ba2d6ec0c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306369 ms
Total Talk Time (AGENT): 99694 ms
Total Talk Time (CUSTOMER): 109993 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/4e30d8ea-b0fc-48f8-adc7-53ba2d6ec0c9_20250128T13:43_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital. I have a couple claims to check the status of.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and that's a direct line.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Policy number is 0243.
[CUSTOMER][NEUTRAL] 0725 M as in Mike L7
[AGENT][NEUTRAL] Thank you and [PII], what is that member's name and date of birth that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This is for a hospital bill.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Could you verify the bill amount? 976-8368.
[CUSTOMER][NEUTRAL] Yes, um, it looks like we billed it for $97,683.68.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looked like we requested the ELB from the primary, so the first time you guys submitted it, we, we requested a primary ELB, and then the second time you submitted it, it was considered as a duplicate because you guys didn't send in the primary ELB.
[CUSTOMER][NEUTRAL] OK, I do have a note here from [PII] and it, uh, it's just notes I'm going off of it looks like they said they faxed over the EOB and emailed it.
[AGENT][NEGATIVE] So we haven't received it.
[AGENT][NEUTRAL] Can you verify where you faxed it over to?
[CUSTOMER][NEUTRAL] Uh, looks like they faxed it to [PII].
[AGENT][NEUTRAL] That's correct. However, we know, I'm not showing it in the system, so you may wanna resubmit it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what you said they send it by email we don't have an email address for someone to submit a claim.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] But the fax number is [PII], but could you put reference to this claim? I'm gonna give you a claim number so that way that they'll know that it's for this claim.
[CUSTOMER][NEUTRAL] I will
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] 355-4183, that's 3554183.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will fax that back over today um to that and I'll make sure it has an attention to that claim number so they'll know what it's for.
[AGENT][NEUTRAL] OK, and is the next claim for the same member or different member?
[CUSTOMER][NEUTRAL] Uh, it's a different member.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] This policy number is 241-9368.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you're calling to check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] I'm not showing the claim on file for [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] I will get that resubmitted over. I'm trying to see, make sure they submitted it, uh.
[AGENT][NEUTRAL] Make sure the dates and I'm checking I'm, I'm not seeing any type of inhospi claim for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'll get it um resubmitted looks like they did submit it but something could have went wrong on our end so I will get that resubmitted over.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, just if you have a reference number.
[AGENT][NEUTRAL] We don't provide those, but you can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] Alright, and I thank you for your help today.
[AGENT][POSITIVE] You're welcome [PII]. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.