AccountId: 011433970860
ContactId: a0c74d47-92c0-4d66-9e9d-7d416ad1c91c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 702059 ms
Total Talk Time (AGENT): 196822 ms
Total Talk Time (CUSTOMER): 180212 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/a0c74d47-92c0-4d66-9e9d-7d416ad1c91c_20250306T16:56_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital. Um, I have 3 claims here to see if an EOB has been received.
[AGENT][NEUTRAL] OK, I can verify that for you, Ms. [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, the first policy number I have.
[CUSTOMER][NEUTRAL] It's 254-498-6.
[AGENT][NEUTRAL] OK, give me one moment and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And what's that patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling to verify we received an EOB for a patient?
[CUSTOMER][NEUTRAL] Uh, yes, we submitted the primary, um, EOB.
[AGENT][NEUTRAL] OK. And do you have the data service and amount of the charge?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the service is 10-1724 through um [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is $52,536.63.
[AGENT][NEUTRAL] OK, and do you have that balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Uh, $4,215.
[AGENT][NEUTRAL] [PII]. OK, thank you, ma'am. Give me one moment, please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And this is for a hospital?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, ma'am. I don't show it has been received. It looks like the claim initially needed that EOB, but I don't show we received it. Um, can you verify if it was mailed or faxed to us?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, it was faxed. I faxed it on [PII].
[AGENT][NEUTRAL] OK, and verify the fax number you sent it to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, that is correct. And you say you sent it on the [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Um, I do not show it's been received.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and I apologize. Did you know if you'll receive a confirmation?
[CUSTOMER][NEUTRAL] Um, let me see if that was uploaded.
[CUSTOMER][NEUTRAL] Um, yes, it looks like it states.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] It is um traced successfully sent tracking number 233-277-0.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Just making sure and see if it.
[AGENT][NEGATIVE] Well, I don't show it's been received. The only thing I can say if you can fax it in to us and um after a minute, give a call back to make sure it's been received because I don't show anything being received on the [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will try and uh fax that over again.
[CUSTOMER][NEUTRAL] Um, is faxed the best way or excuse me, or by mail.
[AGENT][POSITIVE] Uh, fax is the best way since it would come to us quicker, um.
[CUSTOMER][NEUTRAL] Uh, I'll just, uh, I'll refax it over here after, um, after our call and.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See
[AGENT][POSITIVE] Let me type in for this one. But yes, ma'am, if you could, and like I said, just give it a few moments and give us a call back and um see if it's been received because hopefully there's not an issue.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, I'm just typing in a quick note. I apologize.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And Ms. [PII], uh, what's that next policy number?
[CUSTOMER][NEUTRAL] Um, the next one is 01967181 M for Mike, L for Lima, number 8.
[AGENT][NEUTRAL] OK, and that patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It looks like [PII] Last name is spelled [PII] and that date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And what was that date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] Um, $7570.55.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And do you have the balance after primary?
[CUSTOMER][NEUTRAL] Um, the balance after is $2000.
[AGENT][NEUTRAL] OK, and see.
[AGENT][NEUTRAL] OK, and it looks like uh that claim was processed again as the outpatient benefit has maxed for that data service.
[AGENT][NEUTRAL] Let's see what the.
[AGENT][NEUTRAL] And this was processed on [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have a claim number for that?
[AGENT][NEUTRAL] Uh yes, ma'am. It's 3558315.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK. Excuse me, and what is that last policy number or the next policy number?
[CUSTOMER][NEUTRAL] Um, 02281883 M for Mike, L for Lima, number 8.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and amount of the charge.
[CUSTOMER][NEUTRAL] [PII] and $3730.85.
[AGENT][NEUTRAL] OK. And the balance after?
[CUSTOMER][NEUTRAL] Uh, $2320.59.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and it looks like that claim was processed as a duplicate.
[AGENT][NEUTRAL] And let me look at it. It's claim. Give me one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It looks like we received the claim a 2nd time, but there was no EOB attached to it.
[CUSTOMER][NEUTRAL] OK, so just all that's needed is just the EOB this time or?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] And which uh claim number do we need to reference?
[AGENT][NEUTRAL] Uh, claim number 3558563.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I fax that one over today too and.
[CUSTOMER][NEUTRAL] That's all I needed other than if you could just give me your name again and a reference number.
[AGENT][NEUTRAL] Uh yes, ma'am. My name is [PII], last initial [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, Ms. [PII].
[CUSTOMER][POSITIVE] Alright, I thank you so much for your help today.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.