AccountId: 011433970860
ContactId: 4f16ede5-c12a-4f50-b4d3-40fd71bca026
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369070 ms
Total Talk Time (AGENT): 96407 ms
Total Talk Time (CUSTOMER): 89505 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/4f16ede5-c12a-4f50-b4d3-40fd71bca026_20250124T17:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling from Nicholas Children's Hospital following up on a claim status.
[AGENT][NEUTRAL] OK, I can help you with a claim status, Ms. [PII] can.
[AGENT][NEUTRAL] Can I please get your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] This is for [PII].
[AGENT][NEUTRAL] OK, and what's the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, that is 021-84962. M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] Thank you, appreciate that. And then what's the day of service?
[CUSTOMER][NEUTRAL] Uh, this was for [PII].
[AGENT][NEUTRAL] OK, and what's the charge amount?
[CUSTOMER][NEUTRAL] $19,945.89.
[AGENT][NEUTRAL] Thank you. And then what was the charge amount after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] Uh, $5,269.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] back with you again. So I did find the claim.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I found the claim for you and the claim number is 3451322.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Yeah, that's the reason why I'm calling. We had that documentation mailed to you guys, um, that was actually mailed on [PII]. We send it with the tracking number and it was delivered on [PII], so I'm calling to follow up on that.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] Ah, bound it.
[CUSTOMER][POSITIVE] Awesome
[AGENT][NEUTRAL] Oh OK, so it was denied again because it's unable to process as the copies of the major medical explanation of benefits were not legible. Please resubmit legible copies for the major medical EOBs.
[CUSTOMER][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Let me give you the fax number too.
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEGATIVE] Yeah, but the thing is that the last time that I faxed it, you guys never received it, so I have to go ahead and mail it. For some reason faxes are not being received, so I don't, I don't understand what's going on.
[AGENT][NEUTRAL] We also have a payer ID number if you want to send it electronically.
[CUSTOMER][NEUTRAL] Yeah, but we cannot attach a um.
[CUSTOMER][NEUTRAL] We, we cannot, we can't, um, can I get a reference number, please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Perfect thank you very much and you have a wonderful rest of your day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a good weekend. Thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.