AccountId: 011433970860
ContactId: 72abc4a4-8385-49be-b5f1-443343192550
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 663619 ms
Total Talk Time (AGENT): 219180 ms
Total Talk Time (CUSTOMER): 147960 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/72abc4a4-8385-49be-b5f1-443343192550_20250313T12:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital. I have 3 claims here to check the status of if I could.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], are your 3 claims that you're needing to check status on for the same member or for different patients?
[CUSTOMER][NEUTRAL] Uh, different patient, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and [PII], you will use my name along with today's date as your call reference number for each. Also any information that I provide would be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print those by going to our portal which is located at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, first one is 022.
[CUSTOMER][NEUTRAL] 81878 M for Mike L for Larry number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] [PII] and it's $8,156.16.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I am so very sorry, but could you please repeat the billed amount for me one more time?
[CUSTOMER][NEUTRAL] Sure, it's $8150.16.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, are you, your voice is cutting out a little. Is it 8156.16?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, the received date was [PII], and it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3507049.
[AGENT][NEUTRAL] And the reason for the denial on this claim is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will fax that over today. I have the fax number and everything, and it's just attention claims department, correct?
[AGENT][POSITIVE] Yes, ma'am, that is correct. Uh-huh.
[AGENT][NEUTRAL] And did you need any more information on this number?
[CUSTOMER][NEUTRAL] Um, no, not on that one, thank you.
[AGENT][POSITIVE] OK, you're welcome.
[AGENT][NEUTRAL] OK, and what is your next patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02003104 M for Mike, L for Larry, number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], the last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $5,215.75.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was also received. It was received to 10-2025.
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEGATIVE] The claim number is 3563455 and it was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'll get that one faxed over as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any other information that you need on this one?
[CUSTOMER][NEUTRAL] Um, no, I think that's it on that one as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and the next member's policy number, [PII]?
[CUSTOMER][NEUTRAL] 02430725 M for [PII] L for Larry, number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the billed amount is $4,507.57.
[AGENT][NEUTRAL] 57 cents.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, there is no claim on file for him for this data service and that total bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if there's a different.
[CUSTOMER][NEUTRAL] Make sure it was filled with that amount.
[CUSTOMER][NEUTRAL] OK, we will um.
[CUSTOMER][NEUTRAL] Get that resubmitted over.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I have, I do not have anything for 91 or 92 or 93.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll look into that and get it resubmitted um.
[CUSTOMER][NEUTRAL] Over
[AGENT][NEUTRAL] OK, all right, so just one moment.
[AGENT][NEUTRAL] And this is one too that we will have to have the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me, let's see, give me just a second. I just wanna look at a couple of things uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, we don't. I was just double checking one more time, but I'm not able to find anything for September for this, for that date range and build them out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright well I thank you so much for your help today and we will get all this stuff.
[AGENT][NEUTRAL] Why
[AGENT][NEUTRAL] OK. Was that all? I'm sorry, I thought you had 4 of them. You only had 3?
[CUSTOMER][NEUTRAL] Submit it over.
[CUSTOMER][NEUTRAL] Yes, just 3.
[AGENT][NEUTRAL] Oh. Well, I misheard you completely on that one, [PII]. I'm sorry. So, OK, well, if that's all, um, and that is all that I can help you with today?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, and I thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. It was my pleasure and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Yes ma'am, thank you.
[AGENT][NEUTRAL] Papa
[CUSTOMER][NEUTRAL] OK.