AccountId: 011433970860
ContactId: bc845bbe-e08c-4eea-b6ba-99d03a184207
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370339 ms
Total Talk Time (AGENT): 127694 ms
Total Talk Time (CUSTOMER): 78700 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/bc845bbe-e08c-4eea-b6ba-99d03a184207_20250123T14:14_UTC.wav
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[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.
[CUSTOMER][NEUTRAL] I have another claim to check on.
[AGENT][POSITIVE] I, I caught your voice. Hey, [PII], I'll be more than happy to help you.
[AGENT][NEUTRAL] And um is it the same contact number information?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, and may I have the uh member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 02509836.
[AGENT][NEUTRAL] 02509836
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and the 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 for the claim?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Um, let me double check over here.
[CUSTOMER][NEUTRAL] It is $24,178.98.
[AGENT][NEUTRAL] OK, now $24,178.98.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] See I online.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But that's the patient's claim, so I can't even tell her that.
[AGENT][NEGATIVE] But even so, it's not even the same.
[AGENT][NEUTRAL] Total bill, is a different.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So, it looks like we haven't received a claim on file with that total bill.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, or from your provider. We have a few from that day, um, but none of them have the same total bill.
[CUSTOMER][NEUTRAL] OK, uh, let's see, look on another make sure.
[CUSTOMER][NEUTRAL] I know that it was supposed to be um the amount that was left from primary which was uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] Um, but the claim looks like it was billed for that full.
[CUSTOMER][NEUTRAL] Amount
[AGENT][NEUTRAL] What, um, let me see.
[AGENT][NEUTRAL] Yeah, was it, it may have just been built to primary though, because the
[AGENT][NEUTRAL] Even the one that I do have that's like close to this uh balance, the insured submitted it, so I wouldn't even be able to go over claim status, but it's still a different total bill. It's just closer to your total. But there's no timely filing, so you can file at any time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, well we'll resubmit it um does it need to just be submitted directly or can it be faxed or not since it's not been received yet?
[AGENT][NEUTRAL] Um, you can mail it, you can fax it, or you can send it electronically, whichever you prefer.
[CUSTOMER][NEUTRAL] OK, if we fax it over, what all needs to come with it just the claim form or?
[AGENT][NEUTRAL] Um, the claim form, the explanation of benefits from primary, and the itemized billing from, um, from you all as the provider, with the um diagnosis codes, procedure codes, and then all the charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right we will get that resubmitted then.
[AGENT][NEUTRAL] Alright, well, was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Um, no, that is it, and I thank you again for your help.
[AGENT][POSITIVE] You're very welcome. And again, all the information provided was a verification of benefits, not a guarantee of payment. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Bye bye.