AccountId: 011433970860
ContactId: 6f33c1e6-ef89-40bc-9168-cd3928660054
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530440 ms
Total Talk Time (AGENT): 211951 ms
Total Talk Time (CUSTOMER): 179351 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/6f33c1e6-ef89-40bc-9168-cd3928660054_20250320T19:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling for Kids Medical Services INC, and please be informed this call is being monitored and recorded for quality and training purposes. And checking on the time status. Could you please help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number we have.
[CUSTOMER][NEUTRAL] Uh, let me get that. 02273057.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] That's [PII] for the amount of
[CUSTOMER][NEUTRAL] Uh, 1000. Let me go get that double bill 11 more time. Just a moment please. So sorry for the delay. That's 1500 thank you. It's $1,546 even.
[AGENT][POSITIVE] Oh, you're fine. Take your time.
[AGENT][NEUTRAL] $1,526?
[CUSTOMER][NEUTRAL] 546 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] So I'm I'm trying to locate the claim for you. And what's the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes. Um, this is for Kids Medical Services Inc.
[AGENT][NEUTRAL] Is there any other total bill that the um claim could be under?
[CUSTOMER][NEUTRAL] Let me wanna check that here just a moment.
[CUSTOMER][NEUTRAL] You wanna take the claim image.
[CUSTOMER][NEUTRAL] That's 1546 even. That is the bill amount we have here.
[AGENT][NEUTRAL] If that's the only bill amount, then there's no claim on file from your provider, um.
[AGENT][NEUTRAL] We do have a claim on file from Kids Medical, but it's a different total bills. Um, what's your tax ID number?
[CUSTOMER][NEUTRAL] Yes, the tax number we have [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me check this. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then we check for the claim number whether we do have any claim number.
[AGENT][NEUTRAL] So it's the same um tax ID, so it is your provider, but the total bills on this claim is $7,502.
[CUSTOMER][NEUTRAL] $72.
[CUSTOMER][NEUTRAL] But I do not know about that because see we have a different amount. But uh one thing, is it possible to check with the patient's account number?
[AGENT][NEUTRAL] Well, these are the only claims that we have for the patient for this data service.
[CUSTOMER][NEUTRAL] Uh, shall I give you the claim number? Is it possible to check with the claim number?
[AGENT][NEUTRAL] Sure, what's the claim number that you have?
[CUSTOMER][NEUTRAL] That's uh 3541252.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see what happened. This data service was also on those other claims. OK, hold on one moment, let me go back to yours.
[AGENT][NEUTRAL] OK, so this claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 1252.
[AGENT][NEUTRAL] And also on [PII], the claim, um, we paid out on the claim, a total of $1,236.80.
[CUSTOMER][NEUTRAL] Perfect. So that means there is no patient in this claim, paid the primary or allow. There is no patient in this claim, is it right? that order has been paid here.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility.
[CUSTOMER][POSITIVE] Uh, fine. So that is great. We have the mode of payment and before that, may I know when the claim is processed, please?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Perfect. And uh do you, do you have a mode of payment to pay by check or EFT?
[AGENT][NEUTRAL] Sure, let me check for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it was a single check in the amount of $1,238.80.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] It was mailed to [PII].
[AGENT][NEUTRAL] In [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Yes, that's the correct address. [PII].
[AGENT][POSITIVE] OK good.
[AGENT][POSITIVE] OK, and it is still showing as outstanding. So I can send over a request to um Ms. [PII] to check on the check. If it needs to be reissued, we can. If it has in fact been cleared, she'll provide a sort of copy of the cleared check, but we can definitely check on it and get it reissued if we need to.
[CUSTOMER][POSITIVE] Got it. That's, it's not clear yet is it right? That's perfect. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh do you have a business account number?
[AGENT][NEUTRAL] Um, as in like the account number that y'all sent over or their account here with APL?
[CUSTOMER][NEUTRAL] Oh so you don't have that. OK. And uh the kind of already got that. Is it pos is it possible to send the copy of EOB to the same address?
[AGENT][NEUTRAL] No, I'm
[AGENT][NEUTRAL] We, so hold on one second.
[AGENT][NEUTRAL] You asked me a question, so we, I do have a patient account number. I was just asking if like it starts in 4159 and then it has other numbers. Are you wanting the patient account number, or are you wanting the patient's account number with APL? That's all I was asking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, not with the APL, uh, it's a 415, uh, that would be the right, uh, patients account number.
[AGENT][NEUTRAL] Yes, so it's 415-929.
[AGENT][NEUTRAL] V like Victor.
[AGENT][NEUTRAL] 27004.
[CUSTOMER][POSITIVE] Perfect. Thank you. That would be perfect here. And uh then what else is, is it possible to send the copy of EOB to the same address for verify now or also the fax number?
[AGENT][NEUTRAL] Yes, I can fax you a copy of the explanation of benefits. What's a good fax number for you?
[CUSTOMER][NEUTRAL] That's [PII] and attention to patient account number, please.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][POSITIVE] You're right.
[AGENT][POSITIVE] Alrighty, well, I'll go ahead and send this over to you now. And [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And how long it take to receive that?
[AGENT][POSITIVE] Um, I'm sending it now, so we usually say at least an hour. Um, if you haven't received it by end of day today though, you can give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Got it. So we will, uh, wait for the end of the day. Thank you. No issues with that. And everything is perfect and this is the only time today. Is any call the first number first, please, you know.
[AGENT][NEUTRAL] No call reference number, just my name and today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you and have a wonderful day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can help with?
[CUSTOMER][POSITIVE] No, then I think is perfect.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.