AccountId: 011433970860
ContactId: 8f21417d-7464-4247-9749-e1ad355886f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553219 ms
Total Talk Time (AGENT): 236878 ms
Total Talk Time (CUSTOMER): 186868 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/8f21417d-7464-4247-9749-e1ad355886f1_20250501T18:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII], and I'm calling to know the status of a claim that the hospital submitted for me.
[AGENT][NEUTRAL] OK, sure, I can assist you with that. OK. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] For my daughter.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] I do, yes, it's 01813054.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address on file?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and mailing address is [PII].
[AGENT][NEUTRAL] OK, and what is the claim um under which member?
[CUSTOMER][NEUTRAL] It's, it should be under Nicholas Children's Pediatric Specialist, or sorry, Nicholas Children's Hospital.
[AGENT][NEUTRAL] Under which member?
[CUSTOMER][NEUTRAL] It would be under [PII].
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] That's [PII]. OK, let me see if I can find it.
[CUSTOMER][NEUTRAL] Thank you. I've called them a few times already. They keep resubmitting the claim to you uh to APL, but apparently APL is not receiving it, so that's why I'm calling to see if you received it now.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, do you know how long ago they sent it?
[CUSTOMER][NEGATIVE] Oh, they, they sent it 2 weeks ago, a month ago, 2 months ago. I keep calling them and they can just, they say we're gonna escalate it, we're gonna send it again, and then it's like you, APL never receives it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I'm not sure what's going on. I've given them the payer ID. I gave them the fax number.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Mm, do you know how they tell you how they're sending it if they're mailing it or if they're faxing it or what method are they using?
[CUSTOMER][NEUTRAL] I think they have a portal that they use that they were submitting it through, but the last time I called, I, I gave them also the, the fax number, Attention claims, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. Yes, so you gave him the [PII]?
[CUSTOMER][NEUTRAL] 59423, yup, that was on [PII]. So I was hoping that by [PII], which is today, you would have received it, but I guess you haven't.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, I got something here. Let me check and see what is this. OK, one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm waiting on the paperwork to pull up, OK?
[CUSTOMER][POSITIVE] Yeah, sure, no problem.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me look at the documents they sent because it looks like um
[AGENT][NEGATIVE] was incomplete, um, one moment.
[CUSTOMER][NEGATIVE] Yeah, one of the first few times that they sent um APL declined it because it was, it was missing something.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I know that one wasn't valid, but they're gonna resend it, so.
[AGENT][NEUTRAL] Oh, got you. OK, so they, I have not red we have not received the resend. Um, the, the only one I have here is the one that we processed on [PII], um, indicating that, um, we need the explanation of benefits showing the amount applied towards the deductible co-payment and co-insurance. Now, um, Ms [PII], um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] You can go ahead and send that over to us, Ms. [PII]. I'm sorry. um you can send that over to us if you have a copy so we don't have to wait for them. We got the um claim. So right now all we need is that copy of the explanation of benefits for that day. So if you have a copy and you can send it to us, we can go ahead and process this claim because without that copy, we cannot continue the processing of the claim. So that's all we're waiting for.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] OK, yeah, then, then they did resubmit it because that [PII] was the last time I spoke to them and I guess they they submitted it again without it being complete. Um, so my question to you is, what, what is the explanation of benefits? Because what I have here is a statement from the hospital. Is that what you need?
[AGENT][NEUTRAL] No, the explanation of benefits is from your primary insurance which it looks like is um United Healthcare.
[CUSTOMER][NEUTRAL] Yeah, that's my primary. So, let me see if I can maybe find it because they don't send me anything through mail anymore, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know if I can see it in the portal.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and then this one that they sent in, and I'm just gonna give you the information that I see, but this one that I see from Nicholas Children's Hospital is from date of service [PII]. Um, so I don't know if um they're billing a different one from, OK, so it is from the [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, that's the one.
[CUSTOMER][NEUTRAL] Do you have an amount there?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, $19,000 and this is just the total charge. It looks like it was $19,166.18.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that, that should be it between my two bills here, that's the amount.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. So if you can go to the portal of the um United Healthcare and look for that explanation of benefits, the one for that date of service with that amount of 19,16618, and you see an amount applied towards the deductible co-payment and car insurance, just send us a copy of that EOB so we can go ahead and process the claim. The EOB doesn't have to come from the provider, you can send that.
[CUSTOMER][NEUTRAL] OK, yeah, that, that's easier actually because I'm tired of calling them so I'll go ahead and do that um and I send it to what the fax number that I have here attention claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Yes. Correct.
[CUSTOMER][NEUTRAL] OK, all right, and can I call back to to like maybe a little bit later today or tomorrow to see if you received it?
[AGENT][NEUTRAL] Um, it takes 24 to 48 business hours for it to be imaged. It goes to a fax line. From there they sort it out and they image it to the correct policy, so it does take a little bit for it to go into your policy. So I will say call back Monday and we should, we should know if we got it or not, OK?
[CUSTOMER][POSITIVE] OK, perfect. I'll do that. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Have a nice day.
[AGENT][POSITIVE] OK, you're welcome and thank you as well, Ms. [PII] and thank you for calling APL. Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.