AccountId: 011433970860
ContactId: 7b0bdd08-e1b3-4e13-919b-6c7e2a601d21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302119 ms
Total Talk Time (AGENT): 127012 ms
Total Talk Time (CUSTOMER): 115366 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/7b0bdd08-e1b3-4e13-919b-6c7e2a601d21_20250408T19:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, this is [PII]. I'm calling because I submitted a claim, um, well, actually the hospital submitted a claim for my daughter. Um, she was a patient, um, a year ago, and I don't know if APL has reimbursed them. They only reimbursed me $37.50 so I wanna know if, um, I, if, if there was any other payments I should be receiving the APL sent them.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name again and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] [PII] is a good phone number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please?
[CUSTOMER][NEUTRAL] OK, that's 02549490.
[AGENT][NEUTRAL] OK, and please verify your date of birth, then verify your daughter's name and date of birth.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. Her name is [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service on the claim?
[CUSTOMER][NEUTRAL] Oh, I, I don't have that in front of me right now. Um, it was in [PII].
[CUSTOMER][NEUTRAL] And somewhere in [PII], there were a few claims, like a few hospital bills and secondary insurance for.
[AGENT][NEUTRAL] OK, cause I have the policy open for [PII] and I'm not showing any claims for her on file, so they haven't filed any claims for [PII] and I'm about to check under the [PII], uh well, [PII] policy. One moment.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] OK, I'm showing one claim on file for her for um
[AGENT][NEUTRAL] [PII] and these are for the hospital charges. And I'm showing that this claim denied um because according to the EOB that they sent us, the EOB is not showing what went towards the copay, the coinsurance or deductible. So we sent them a letter requesting um for them to resubmit the claim with the correct information so that we can get the claim processed and paid, but we never heard back from them.
[AGENT][NEUTRAL] So, but there's no timely filing limit. So if you reach out to them and let them know that they can resubmit this claim, um, we'll receive it and process it for you guys.
[CUSTOMER][NEUTRAL] OK. Um, and which one was that one for the [PII]?
[AGENT][NEUTRAL] Um, November, yeah, [PII]. The hospital charges.
[CUSTOMER][NEUTRAL] OK, so the, so the right thing to do here is just to submit it, uh, the whole claim, is that what they have to do?
[AGENT][NEUTRAL] Yeah, they would have to submit the whole claim again along with the updated explanation of benefits which shows what went towards the um copay core insurance or deductible because those are the portions that we pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And um I did receive a $37 check. What, what did that go to? Because I know it was for
[CUSTOMER][NEUTRAL] It was for Nicholas Children's Hospital as well.
[AGENT][NEUTRAL] Um, it was from us, a check from us?
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] No, it was from the hospital, but I, I guess it was because APL had paid them already, so they paid me just $37 so I wasn't sure why that small amount if I had paid like $800 back then for each of my bills.
[AGENT][NEGATIVE] No, ma'am. I'm not showing any claims for your daughter, um, that we've paid so far. Like I said, for [PII], we haven't received any claims. And for your old policy for [PII], there's only this one claim on file for her that denied.
[CUSTOMER][POSITIVE] OK, OK, great then I'll just give them a call and tell them to resubmit that claim. Thank thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you. You've been helpful.
[AGENT][POSITIVE] Yeah, thank you for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank