AccountId: 011433970860
ContactId: 941f245c-7beb-49bf-a03c-8128d079d035
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 688130 ms
Total Talk Time (AGENT): 209369 ms
Total Talk Time (CUSTOMER): 191495 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/941f245c-7beb-49bf-a03c-8128d079d035_20250612T15:23_UTC.wav
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[CUSTOMER][NEUTRAL] If the function.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital, um, to check two claim statuses, please.
[AGENT][POSITIVE] OK, well, 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][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's 02556481 M for Mike L for Larry, number 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, it's 1029 of 24 and the total bill is $3,234.30.
[AGENT][NEUTRAL] I'm sorry, can you repeat the total bill? There were messages coming in and it blocked you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's OK, uh, it's $3,234.03.
[AGENT][NEUTRAL] Thank you. And the um date of birth again, can you repeat for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And did you have any other data service or the other claim is a different member?
[CUSTOMER][NEUTRAL] Um, other claims are different member.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] Alright, so I just located the claim. I'm waiting for it to come up now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 9158.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting a detailed explanation of benefits that shows the amount paid to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have the fax number as well for
[CUSTOMER][NEUTRAL] You all so I can fax the EOB over.
[AGENT][NEUTRAL] OK, and did you, you said you do have the fax number or you need it?
[CUSTOMER][POSITIVE] Um, I do have it, yes.
[AGENT][NEUTRAL] OK, and then hold on, let me note this one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hold on one moment I'm gonna note this one and then we can move to your second one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and the next one's policy number when you're ready.
[CUSTOMER][NEUTRAL] 01480322
[AGENT][NEUTRAL] 01480322.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bills?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the total bill is $5,292.90.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said it was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me see if there's, so I'm so far when I put in, because I can't put a range, so I put [PII] and then I put [PII], but I don't see anything on file for either date. Um, hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this is [PII] as well, right? For or would the provider be different?
[CUSTOMER][NEUTRAL] No, it's the same. Mhm.
[AGENT][NEUTRAL] Just to be on the safe side, hold on one second.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] that
[AGENT][NEUTRAL] Yeah, so there's no claim on file for [PII] with that total bill. Do you have a claim number?
[CUSTOMER][NEUTRAL] Um, let me go through my notes here and see if someone might have gotten one.
[AGENT][NEUTRAL] Just to make sure.
[CUSTOMER][NEUTRAL] No, it looks like I'm actually the one that called back in March and the same thing was stated there was no claim on file so I did have another one submitted making sure that primary ELB was attached, uh, it looks like that one.
[CUSTOMER][NEGATIVE] That one actually, it states that it denied.
[AGENT][NEUTRAL] It says it deny
[CUSTOMER][NEUTRAL] Because of the ELB because I.
[CUSTOMER][NEUTRAL] They didn't attach the ELB to the first one, so I had it.
[CUSTOMER][NEUTRAL] Resubmitted with the EOB but there was no added on it.
[CUSTOMER][NEUTRAL] I wanna see if there's anything.
[AGENT][NEUTRAL] Wait a minute, you said there was no, so it's been submitted and you received the denial on it?
[CUSTOMER][NEUTRAL] Well, the first one on, on, um, from just from what I'm seeing that we don't have an EOB or anything like that. I don't even see a claim number let me see if I can locate one.
[CUSTOMER][NEUTRAL] Right here, let's see.
[CUSTOMER][NEUTRAL] This is just a an amount like it we didn't get a, a um a remit for it or EOB anything like that um but it does state that uh there was information needed.
[AGENT][NEUTRAL] What um, do you, do you, oh, you said you didn't get a, do you have a claim number?
[CUSTOMER][NEUTRAL] So that A1.
[CUSTOMER][NEUTRAL] No, there was no claim number because when I called there was no claim on file so I had it resubmitted and then that one it looks like it it states on our end that it denied needing.
[CUSTOMER][NEUTRAL] Um, additional information.
[AGENT][NEUTRAL] Yeah, that's what I'm trying to get to because if y'all got that answer from, I'm just trying to, because when I put the dates in, it's just blank, so I'm
[CUSTOMER][NEUTRAL] But there's not
[AGENT][NEUTRAL] Are are those reasons there saying it's from us or it was just put there?
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Because I, if y'all got that reasoning, then there should be a way for me to locate the claim is what I'm saying. I can, I can search.
[AGENT][NEUTRAL] Differently
[CUSTOMER][NEUTRAL] I'm looking for a claim number that I'm not, I'm not seeing them.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let me try that again, hold on one second.
[AGENT][NEUTRAL] 0101 2025.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm not sure because when I put I usually when it's a date range, I'll put the first date and then it will come up and you'll see the range or I'll put the last date and um you can see it, but when I put either or it's just blank here for those dates.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well that's all right. I can just, uh, if can the claim be faxed over as well like the UBO4 and things like that, or does it need to be submitted?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, you can fax it, you can mail it or um send it electronically.
[CUSTOMER][NEUTRAL] OK, I will go ahead and I'll send that, that claim form and the primary ELB. I'll just send it by fax as well.
[AGENT][NEUTRAL] All right, and you said you do have the fax number or you need it?
[CUSTOMER][POSITIVE] I do have it, yes.
[AGENT][NEUTRAL] OK. Well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, if I can just have a reference number, I think that's it.
[AGENT][NEUTRAL] Alright, well, there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, and I thank you so much for your help today.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.