AccountId: 011433970860
ContactId: b9501ccf-b17f-4801-bcd6-6b1095cc8e02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 775700 ms
Total Talk Time (AGENT): 212380 ms
Total Talk Time (CUSTOMER): 154326 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/b9501ccf-b17f-4801-bcd6-6b1095cc8e02_20250619T20:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling from Nicholas Children's Hospital provider office. I'm looking for a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have your name again? I didn't quite catch your name.
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is uh
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02144106.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Date of service is [PII]. That is $1,885.26.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future, you can check claim status online through our website and.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And bear with me, let me see if I can find this time you said [PII], correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me pull this on me one moment.
[AGENT][NEUTRAL] I'm still waiting on the AB. One moment.
[CUSTOMER][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] First, give me your name, please.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Could you spell, uh, spell out your name?
[AGENT][NEUTRAL] Oh, sure. Yes, that's [PII]. That's an [PII].
[CUSTOMER][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] You're welcome. All right, we processed the claim on [PII] and the claim was denied. The reason for this denial is that we have received the explanation of benefits. However, the explanation of benefits did not list the amount applied towards the deductible co-payment or coinsurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So needed primary only, right?
[AGENT][NEUTRAL] Um, if you have a detailed EOB that has the uh the deductibles, co-payment, and co-insurance, then we need a copy of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the claim number this client?
[CUSTOMER][NEUTRAL] Give me claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim, yes, the claim number is 3593435.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, I, uh, I have 2 more friends so please give me the there.
[AGENT][NEUTRAL] Is it a different member or the same member?
[CUSTOMER][NEUTRAL] A different number.
[AGENT][NEUTRAL] OK, let me make a note on this one.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] All right, and what is the next policy number?
[CUSTOMER][NEUTRAL] Next policy number is 02501804.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Member ID is uh
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what is the data service? Mhm.
[CUSTOMER][NEUTRAL] Already given that.
[CUSTOMER][NEUTRAL] Date of service, March.
[CUSTOMER][NEUTRAL] [PII] charges $1,074.60.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it's gonna be the same denial reason.
[AGENT][NEUTRAL] Now the claim was processed. Let me see.
[AGENT][NEUTRAL] One.
[AGENT][NEUTRAL] The claim was processed on [PII]. It was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the reason?
[AGENT][NEUTRAL] It's the same reason. We need a detailed explanation of benefits showing the amount applied towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me your number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Claim number on this one is.
[AGENT][NEUTRAL] 359-6570.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And more next time.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next policy?
[CUSTOMER][NEUTRAL] My policy number is.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] My policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02430725.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] First name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Then [PII], chargers.
[CUSTOMER][NEUTRAL] $7,423.13 sir.
[AGENT][NEUTRAL] It was [PII]?
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't see a claim for that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Date of service [PII], [PII].
[AGENT][NEUTRAL] I don't see that claim on file.
[CUSTOMER][NEUTRAL] My patient is active only service.
[AGENT][POSITIVE] Mhm, yes, um, we have an effective date.
[AGENT][NEUTRAL] Of [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The termination date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you give me call reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like this for you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a good afternoon.