AccountId: 011433970860
ContactId: 74e2e6f3-ef21-4274-bdd4-f1f815bab8fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1385780 ms
Total Talk Time (AGENT): 409574 ms
Total Talk Time (CUSTOMER): 390561 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/74e2e6f3-ef21-4274-bdd4-f1f815bab8fc_20250217T19:47_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] Your name is [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII]. And your last initial name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII].
[AGENT][POSITIVE] I, I do apologize. Do you mind spelling that again? I apologize.
[CUSTOMER][NEUTRAL] [PII]. I'm calling from Nicholas Hospital provider office.
[AGENT][NEUTRAL] All right, thank you. And how do you pronounce your name?
[CUSTOMER][NEUTRAL] Oh yeah
[AGENT][POSITIVE] [PII], thank you. What is a good callback number please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Patient policy number is uh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yes. 02465765.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK her name is [PII].
[CUSTOMER][NEUTRAL] [PII] and date of birth is, date of birth, sorry, [PII].
[AGENT][POSITIVE] Thank you, [PII]. And how can I help you with this policy?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Are you needing eligibility or claim status?
[CUSTOMER][NEUTRAL] Claus.
[AGENT][NEUTRAL] Alright, I can help you with that. What is that date of service please ma'am?
[CUSTOMER][NEUTRAL] Date of service is uh [PII].
[AGENT][NEUTRAL] And what is the, mhm.
[CUSTOMER][NEUTRAL] Charges 1000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 243 cents.
[AGENT][NEUTRAL] All right, thank you. And the name of the facility?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] I'm checking, bear with me just one moment.
[AGENT][NEUTRAL] Is that the billing provider name?
[CUSTOMER][NEUTRAL] Yes, Nicholas Children Hospital is known as a variety Children's Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For Nicholas Children's Hospital, I do not have that claim on file.
[CUSTOMER][NEUTRAL] Claim on file.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Not for Chi uh Nicholas Children's Hospital.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Actually, Glenville Miami Lake Outpatient Center under the Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for Miami Lakes outpatient?
[AGENT][NEUTRAL] Center, I do have that claim on file.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It was processed and pending for the primary EOB. We're secondary to the policyholder's major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's pending for that EOB.
[AGENT][NEUTRAL] And I can provide the
[CUSTOMER][NEUTRAL] What is the claim received?
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII], 10-124.
[CUSTOMER][NEUTRAL] And process.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And claim number?
[AGENT][NEUTRAL] Claim number is 351-2149.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure. You can actually fax that EOB to our claims department once you receive it, and I can provide that fax number for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Our claims fax number is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Sorry, could you repeat that? 877.
[AGENT][NEUTRAL] Mhm. 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] City, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Mhm. Thank you. And
[CUSTOMER][NEUTRAL] I have 7 claims, so please give me details.
[AGENT][POSITIVE] Uh, it would be my pleasure. Is different patients.
[CUSTOMER][NEUTRAL] Yes, different patient.
[AGENT][POSITIVE] All right. I am ready for the next one whenever you are.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] 02408941.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is that name and date of birth?
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] Name [PII].
[CUSTOMER][NEUTRAL] [PII] and
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that data service.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, bear with me just one moment. This policy turned on 9124. Let me see if they have an active policy for that data service.
[AGENT][NEUTRAL] Bear with me just one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um, let me give you the active policy number if you don't mind.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] For [PII], um, active policy number for that data service and this is a current policy. Policy 254.
[AGENT][NEUTRAL] 9410.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you. 2,549,410, right?
[AGENT][NEUTRAL] 2,549,410
[CUSTOMER][NEUTRAL] Sorry, could you repeat that? 25?
[AGENT][NEUTRAL] 2,549,410
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that date of service was 9-18-24?
[CUSTOMER][NEUTRAL] Uh, 9:18, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me, now I'm checking for that data service we do not have that claim on file.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it would need to be resubmitted to the same information as the last policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And claim the received on?
[AGENT][NEUTRAL] We do not have that claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim on file, right?
[AGENT][NEUTRAL] That's correct. So that one will need to be resubmitted, and you can resubmit it either by fax or by mail. We will need the primary EOB also.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And policy num, initial policy already terminated. So this policy 254.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] 4910 is active on that of service, right?
[AGENT][NEUTRAL] 2,549,410. The effective date was [PII] and the policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Can I move next claim, please?
[AGENT][NEUTRAL] Yes, ma'am. What is that?
[CUSTOMER][NEUTRAL] Call reference number, please. Give me call reference number.
[AGENT][NEUTRAL] The call reference is my name and today's date. I spell my name [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] And I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Next claim policy number is uh
[CUSTOMER][NEUTRAL] 02440231
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] Selling dollars.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Charges is $4,385.61.
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I don't have a claim on file for that date of service either.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member is active on of service.
[AGENT][NEUTRAL] Yes, ma'am. The effective date is [PII] and the policy is active.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I ask him?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] My policy number is 0174050.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] Name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] My address and date of birth is [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Date of service, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] charges 9.
[AGENT][NEUTRAL] That's [PII]
[AGENT][NEUTRAL] I'm sorry, is that [PII]? Got you. Thank you.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, and that charge amount?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] $968.98.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is that facility name please, ma'am?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just you.
[CUSTOMER][NEUTRAL] The the name is uh Doral Outpatient Center under the Nicholas Children's Hospital.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that that claim we received on [PII] and processed on [PII], and the claim is pending for the primary EOB.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Give me claim number.
[AGENT][NEUTRAL] 354-700-06
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'm ready whenever you are for the next.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] 024
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 65765
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah. [PII] and date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And date of service, mhm.
[CUSTOMER][NEUTRAL] Date of, date of service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So this is uh $61.96 dollars 22 cents.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that facility name?
[CUSTOMER][NEUTRAL] It's um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Miami Lake Outpatient Center under the Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, bear with me just one second.
[AGENT][NEUTRAL] Can you provide that tax ID number please ma'am?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] That claim is pending for the primary EOB. Now we have it, let's see, and you said Miami Lakes Outpatient Center?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it's pending for the primary EOB.
[CUSTOMER][NEUTRAL] OK. Give me the date and process date and claim number.
[AGENT][NEUTRAL] Receive 10 9 24, process 1014 24.
[AGENT][NEUTRAL] Claim number 351.
[AGENT][NEUTRAL] 7254
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I move next time?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] 2502657.
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] Please, [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's done is no, sir.
[CUSTOMER][NEUTRAL] Date of birth is [PII], [PII].
[AGENT][NEUTRAL] Data, sir.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] [PII] charge is uh $696.22.
[AGENT][NEUTRAL] Name of the facility, is it the same as last?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Miami Lakes Outpatient Center.
[CUSTOMER][POSITIVE] Yes, all right.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] NPI number is the same.
[AGENT][NEUTRAL] OK, thank you. That claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And pending primary EOB.
[CUSTOMER][NEUTRAL] Mhm. The number.
[AGENT][NEUTRAL] Claim number is 351.
[AGENT][NEUTRAL] 7007.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 700
[AGENT][NEUTRAL] 7
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And I'm ready.
[CUSTOMER][NEUTRAL] Yeah, next policy number is
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 03123
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Man
[CUSTOMER][NEUTRAL] [PII]. Date of birth is uh [PII].
[CUSTOMER][NEUTRAL] Charges is uh
[CUSTOMER][NEUTRAL] [PII] range.
[CUSTOMER][NEUTRAL] [PII], sorry, [PII] date of service charges $725.02.
[AGENT][NEUTRAL] Is that [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. I apologize. Sometimes those numbers are ha[PII] to distinguish over the phone. I do apologize.
[AGENT][NEUTRAL] Same facility as last.
[CUSTOMER][NEUTRAL] Just a moment. I'll check.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And that claim we've received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And pending for primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is 351.
[AGENT][NEUTRAL] 2844
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'm ready for the next.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This one.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] So thank you so much. 7 claim is done. So, I thank you. Thanks.
[AGENT][POSITIVE] Oh, wow.
[AGENT][POSITIVE] It's been my pleasure. That was fast.
[AGENT][POSITIVE] It was my pleasure to assist you. Pos. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome. I hope you have a lovely afternoon.
[CUSTOMER][POSITIVE] Bye-bye. I appreciate it. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.