AccountId: 011433970860
ContactId: 6a165668-8d94-4a24-9458-dd8394ab3c00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2358580 ms
Total Talk Time (AGENT): 517005 ms
Total Talk Time (CUSTOMER): 655363 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/6a165668-8d94-4a24-9458-dd8394ab3c00_20250303T18:29_UTC.wav
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[AGENT][POSITIVE] Thank you for calling AP.
[AGENT][NEUTRAL] Yeah, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII], and I'm calling from provider office, and I want to know about claim information. Could you please help me also for that?
[AGENT][NEUTRAL] Yes, I can help you with claim information [PII]. um, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. And it is the direct line.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. So, the name of the patient is [PII]. And the date of birth of this member is
[CUSTOMER][NEUTRAL] [PII]. And the member ID is 18522275.
[AGENT][NEUTRAL] OK, let me look up that patient real quick.
[AGENT][NEUTRAL] And that policy number was 18522275.
[CUSTOMER][POSITIVE] Mhm. That is correct.
[AGENT][NEUTRAL] OK, I do not see that policy is not a good policy number. Do you find another one?
[CUSTOMER][NEUTRAL] Uh, no, I don't have any other uh other policy number. Sorry for that.
[AGENT][NEUTRAL] OK, and then the patient spells their name [PII]?
[CUSTOMER][NEUTRAL] Uh no, it is [PII]
[AGENT][NEUTRAL] OK, and then [PII]
[CUSTOMER][POSITIVE] Mhm. Right. It is correct.
[AGENT][NEUTRAL] OK, OK, alright, let me look and see if I can find them by the name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what state does [PII] live in?
[CUSTOMER][NEUTRAL] Uh, it is for [PII].
[AGENT][NEUTRAL] [PII]. Do you have the address?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, let me see if I can find [PII] in [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII]. Let me see.
[AGENT][NEUTRAL] OK, I believe I have them. What is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is 61068 cents.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, I don't know the details for that. Sorry for that.
[AGENT][NEUTRAL] OK and then what is the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] It is Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you, Miss [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, Miss [PII]. I do have the claim, uh, the claim number is 343-5875.
[AGENT][NEUTRAL] The claim was received.
[CUSTOMER][NEUTRAL] Uh, just, just give me, just give me a second, just give me a second. Sorry for that.
[CUSTOMER][NEUTRAL] Uh, sorry for the holding. It is, it was something urgent. Uh, so could you please, uh, repeat the claim number?
[AGENT][NEUTRAL] Yes, it was 343.
[AGENT][NEUTRAL] 5875.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. Outpatient benefit.
[CUSTOMER][NEUTRAL] Calendar.
[CUSTOMER][NEUTRAL] Is met, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Thank you so much for this information, [PII]. And uh uh actually, [PII], I have like couple claims. Could you please help me also for those claims and before that, could you please provide me the call reference number?
[AGENT][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] And you can use my name and today's date for your reference number and how many claims do you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I have like, just give me a second.
[CUSTOMER][NEUTRAL] I have 7 more claims.
[AGENT][NEUTRAL] OK, let's move on to the next patient.
[CUSTOMER][POSITIVE] Mhm. Thank you so much for that. So may I provide the next member ID or something else?
[AGENT][NEUTRAL] I'll need their name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] Named it. OK. OK. It is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the member ID is 1252269 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's look that one up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are all of them gonna be for Nicholas Children's Hospital?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what's the date of service and the charge amount with and without primary?
[CUSTOMER][NEUTRAL] Uh yeah. The date of service is [PII] and the charge amount is 2,971 43 cents.
[AGENT][NEUTRAL] OK, and the amount after the primary paid?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, there is the primary is United Health Insurance and it is, uh, there is no payment, but there is patient responsibility.
[AGENT][NEUTRAL] OK, let me go ahead and put you on a hold and I'm gonna look this one up real quick.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 347-854-9
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you very much for holding for me.
[AGENT][NEUTRAL] So looking at this one, the claim number is 347.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 854 9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] I'm looking at the date that we got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received it on [PII].
[AGENT][NEUTRAL] And processed it on [PII].
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Uh, OK. OK, no problem. Actually, in this claim, there is, uh, the previous note, the uh, the claim already uh resubmit, rebuild the as a paper claiming center and with the primary of this. So we need to um
[CUSTOMER][NEUTRAL] Uh, we need to upload again. We, we need to rebuild the claim again for this, right?
[AGENT][NEUTRAL] Right, but we need the primary insurance explanation of benefits with the claim.
[CUSTOMER][POSITIVE] OK, OK. No problem. Thank you so much for this. So may I provide you with the next uh name?
[AGENT][NEUTRAL] Yes, name, date of birth, and policy number, please.
[CUSTOMER][NEUTRAL] Uh-huh. The name is [PII] and the date of birth of this member is
[CUSTOMER][NEUTRAL] It is [PII] and the policy number is
[CUSTOMER][NEUTRAL] It is 244-3500.
[AGENT][NEUTRAL] OK, let me look that one up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is 654. 63 cents.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, the amount of paid by USC and it is not, there is no payment. There is uh the patient responsibility of 206.
[AGENT][NEUTRAL] OK. And then what uh Nicholas Children's Hospital also?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold I'm gonna look that one up for us and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. I've got this claim ready for you. It is claim number 3466211.
[AGENT][NEUTRAL] Received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied for the same reason, we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for this. So may I provide your next member name or ID?
[AGENT][NEUTRAL] Yes, what is the member's name?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID is
[CUSTOMER][NEUTRAL] It is 02440231 M [PII].
[AGENT][NEUTRAL] OK, let me pull that one up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK and then what is the data service?
[CUSTOMER][NEUTRAL] The date of service of this member is?
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] It is 1,727 05 cents.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary insurance paid?
[CUSTOMER][NEGATIVE] Mm, no, I don't have the, any limit for this, uh, sorry for that. I don't have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look on this one for you. I'm gonna put you on a brief hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] OK, thank you so much. I've got this one ready for you. So this one was denied um.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] And it was denied because we need, I'm sorry, it was denied because the out calendar year benefits for the year have been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He has been met.
[CUSTOMER][NEUTRAL] OK. Uh, so may I have the claim number?
[AGENT][NEUTRAL] Yes ma'am, the claim number is 356-761-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. So may I provide the next member name or?
[CUSTOMER][NEUTRAL] or other details? Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID is
[CUSTOMER][NEUTRAL] [PII] M as in Mary, L as in [PII], number 8.
[AGENT][NEUTRAL] OK, let me look up this one.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and the charge amount please.
[CUSTOMER][NEUTRAL] It is 7,423. 13 cents.
[AGENT][NEUTRAL] OK, and what is the amount after the primary paid?
[CUSTOMER][NEUTRAL] Um, just give me a second.
[CUSTOMER][NEUTRAL] It is paid, uh, the primary have made and it is paid 2,372. 33 cents.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that's what the
[AGENT][NEUTRAL] What's left is 3,732 cents.
[CUSTOMER][NEUTRAL] Uh, no, it is 2,372 and 33 cents.
[AGENT][NEUTRAL] OK, thank you. Alright, I'm gonna put you on hold. I'm gonna look this one up for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, looking at this
[AGENT][NEUTRAL] One for LO for data service [PII] through [PII] there is no claim on file.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. No claim on file.
[CUSTOMER][NEUTRAL] Uh, so do you have member eligibility? What is the date of full effective and um, something else?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The effective date of the policy is [PII].
[AGENT][NEUTRAL] And the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK. So, the claim is
[CUSTOMER][NEUTRAL] Uh, now term, right?
[AGENT][NEUTRAL] The policy is terminated [PII].
[CUSTOMER][POSITIVE] Yeah, yeah, yeah. OK. Thank you so much for this. So, may I provide the next member name and date of birth and
[CUSTOMER][NEUTRAL] ID
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the name is [PII], and the date of birth of this is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh the member ID is
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It is 02462030, M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, let me find that policy.
[CUSTOMER][NEUTRAL] Uh-huh. Sure.
[AGENT][NEUTRAL] OK, and what is the data of service for [PII]?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, the charge amount of this number is 2,31798 cents.
[AGENT][NEUTRAL] OK, and then the charge after the primary paid?
[CUSTOMER][NEUTRAL] Uh, there is the primary is Ame and it is paid 534 and 47 cents.
[AGENT][NEUTRAL] OK, and what's the balance for the patient after the primary paid?
[CUSTOMER][NEUTRAL] Uh, there is no any balance showing, uh, in my system. Sorry for that. And but there is the patient responsibility is 300.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 300. OK, alright, I'm gonna put you on hold and look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me so this claim number is 351.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] 9179 claim was processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9179.
[AGENT][NEUTRAL] Yes, the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Just give me a sec, just, uh, sorry for that. Just give me a sec.
[AGENT][NEUTRAL] And the claim was denied because.
[CUSTOMER][NEUTRAL] Uh, sorry for that. Please, uh, continue.
[AGENT][NEUTRAL] OK, so the claim number is 351-917-9. claim was processed on [PII] and it was denied because we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Uh, OK. Thank you so much. So may I have the received date or something else? Uh, the receipt is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the process date?
[AGENT][NEUTRAL] It was also [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. So may I provide the next?
[AGENT][NEUTRAL] Yes ma'am, what's the next one?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, the next one is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID is?
[CUSTOMER][NEUTRAL] Mm it is.
[CUSTOMER][NEUTRAL] 021 00291 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the day the service for Emma?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] It is 1,41144 cents.
[AGENT][NEUTRAL] And the amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The primary sunshine and uh it is paid 1012, 44 cents, but there, there is no NPR.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold again. I'll be right back. I'm gonna check this one out for you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You are.
[AGENT][NEUTRAL] OK, thank you for holding for me uh on Emma, there's no claim on file for the date of service, but the policy did lapse.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Terminated on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy that I show that is active.
[AGENT][NEUTRAL] The member is no, is not on the active policy.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][POSITIVE] On date of service. OK. Thank you so much for this information. And may I have the last member name?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Thank you so much. So, so the next one is [PII] and the date of birth of this member is [PII].
[CUSTOMER][NEUTRAL] And the member ID is?
[CUSTOMER][NEUTRAL] It is 01822968 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, let's look that one up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All right, and what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] And the charge amount is, it is 2,461 66 cents.
[AGENT][NEUTRAL] OK, and then the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, uh, sorry for that. I don't have the any EUB for the primary for this.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold and look this one up and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me. Uh, so for a lease on data service [PII], I found claim number 352.
[AGENT][NEUTRAL] 1760.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] And processed also on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because we need the EOB from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Uh, OK. Thank you so much for this. Actually, in this claim, as you, um, told me, the claim is denied for the missing primary EUB. So as per the previous note, there is already uploaded the primary EUB which is USC and uh send the claim to billing department and billing team that
[CUSTOMER][NEUTRAL] Uh, response that reviewing action law generated claim 277-050-662 uh American Public Life. Primary care information be, to be used in SSI. So, so the claim is denied as well, um, like you said this.
[AGENT][NEUTRAL] Right, and we still have not received the primary EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] Modi insurance. OK. OK, [PII], thank you so much for your all your help and have a great day. Thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. You have a great day too, and thanks for calling APL. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Mhm. OK.