AccountId: 011433970860
ContactId: 659562ef-fdcf-4bca-af6b-335f81332ba0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557219 ms
Total Talk Time (AGENT): 105884 ms
Total Talk Time (CUSTOMER): 136148 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/659562ef-fdcf-4bca-af6b-335f81332ba0_20250220T19:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital. I have two claims here. If I could get a status of them, please.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the claim status. What is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[CUSTOMER][NEUTRAL] And that policy number is 02123355M as in Mike 7.
[AGENT][NEUTRAL] OK let me pull that up real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the total charge is $3,755.05.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, looks like $2,461.
[AGENT][NEUTRAL] Thank you. I'm gonna put you on a brief hold [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 356-6305.
[AGENT][POSITIVE] OK, thank you for holding for me, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Looking on data service for [PII], I don't find a claim on file for your facility or the amount given.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll, I'll have that claim uh.
[CUSTOMER][NEUTRAL] Resubmitted them and I'll make sure they attach that primary ELB.
[AGENT][POSITIVE] OK, thank you. I appreciate that, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, um, I just have one more claim for a different member whenever you're ready.
[AGENT][NEUTRAL] OK, what's that member's name?
[AGENT][NEUTRAL] The date of birth and the policy.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] Uh, let's see, that date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02446815M for Mike 7.
[AGENT][NEUTRAL] OK, let me look up that policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] And then what is the data service for this one?
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Uh, 12 3 24 through 127 of 24.
[AGENT][NEUTRAL] In the charge amount?
[CUSTOMER][NEUTRAL] $18,580.59.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, looks like that'll be um $1,671.06.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold again Miss [PII] I'll be right back.
[CUSTOMER][NEUTRAL] OK, thank you. You are on hold.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is Toy back again. So I did find the claim on this one. It is the number is 355-9074.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I do have the fax number and all that, so for this one I'll get that, uh, it'll be sent over for fax today.
[AGENT][POSITIVE] OK, awesome. Thank you so much. We appreciate it.
[CUSTOMER][NEUTRAL] You're welcome. And do you have a reference number for me?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right, and I thank you for your help today.
[AGENT][POSITIVE] Thank you [PII] you have a good day and thanks for calling APL.
[AGENT][NEUTRAL] Bye ma'am.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.