AccountId: 011433970860
ContactId: 59ef8b03-1bd4-456e-b802-27b05d5f4b9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323179 ms
Total Talk Time (AGENT): 135655 ms
Total Talk Time (CUSTOMER): 90112 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/59ef8b03-1bd4-456e-b802-27b05d5f4b9d_20250415T19:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, myself [PII]. I'm calling from Children Hospital provider office. I'm looking for clinic status.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm sorry, I could not understand what you said.
[CUSTOMER][NEUTRAL] Myself [PII]. I'm calling from Nicholas Children's Hospital provider office. I'm looking for claim status. Give me your name, please.
[AGENT][NEUTRAL] What is your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hey, [PII], my name is [PII].
[AGENT][NEUTRAL] And you're needing points?
[CUSTOMER][NEUTRAL] Your name is [PII], right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And you're needing claim status?
[CUSTOMER][NEUTRAL] Uh, last year?
[AGENT][NEUTRAL] S
[CUSTOMER][POSITIVE] Thank you, [PII]. And yes, I'm looking for claim.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims for you do you need to check status on?
[CUSTOMER][NEUTRAL] Only I have one.
[AGENT][NEUTRAL] OK. Yes, ma'am, I can help you. And what is that member's policy number?
[CUSTOMER][NEUTRAL] 01746207.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you today, Puja will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is uh [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][POSITIVE] Total good amount is
[CUSTOMER][NEUTRAL] $2,155.56.
[AGENT][NEUTRAL] OK, just a moment. Give me the date of service first.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again the bill to mail please.
[CUSTOMER][NEUTRAL] The amount is.
[CUSTOMER][NEUTRAL] 215556
[AGENT][NEUTRAL] 2155.56. Is that correct?
[CUSTOMER][NEUTRAL] No, $2,155.56.
[AGENT][NEUTRAL] Yes ma'am, that's what I said. OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356-912-13569121.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] And the reason for the denial states, please provide copies of your explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Give me your address.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] For meeting
[CUSTOMER][NEUTRAL] Give me mailing address for your business.
[AGENT][NEUTRAL] The same as the claims [PII].
[CUSTOMER][NEUTRAL] Which address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am, and if you need a copy of this explanation of benefits to, you can print it from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else
[CUSTOMER][NEUTRAL] Give me a call reference number.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a nice afternoon.