AccountId: 011433970860
ContactId: c3001724-8da5-4fff-aad1-fe22b46caac4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470470 ms
Total Talk Time (AGENT): 123074 ms
Total Talk Time (CUSTOMER): 128953 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/c3001724-8da5-4fff-aad1-fe22b46caac4_20250207T14:45_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. Um, I have about 3 claims to get a status of if I could.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to assist you with the claim status, and are they different patients or it's the same member?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Um, it'll be different patients, the same tax ID.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected, [PII], and then the first member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And that first policy number is 01935547 M for Mike L for Lima 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, yes, it's 12:29 of 24.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $2,283.52.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And you said this is from [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we only have one claim on file for that data of service, but it's a different total bill, um.
[AGENT][NEUTRAL] Could there be any other total bills or if that's it, then we don't have it on file yet.
[CUSTOMER][NEUTRAL] Um, that's the only total bill that I see for him, so no cleaning file.
[CUSTOMER][NEUTRAL] Let me see in another place just to make sure they didn't.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And what, can you repeat the total again? I just want to make sure I wrote it down right.
[CUSTOMER][NEUTRAL] Uh yes, it's $2,283.52.
[AGENT][NEUTRAL] OK, yeah, no, this is a different total bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, we will resubmit that one.
[AGENT][NEUTRAL] Alright, and we can move on to the 2nd 1 whenever you're ready.
[CUSTOMER][NEUTRAL] Um, OK, the next member ID is 02565549.
[AGENT][NEUTRAL] Thank you for that. And um can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And then the date of service and total bill.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 1213 of 24 total bill is $3,025.77.
[AGENT][NEUTRAL] OK, so I'm showing that this claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3554892.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do have the fax number and everything for that and that's just attention uh claims department.
[AGENT][POSITIVE] Yes, mhm, that's correct.
[CUSTOMER][NEUTRAL] OK, I will fax that. It'll be over.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, and whenever you're ready for the 3rd 1.
[CUSTOMER][NEUTRAL] OK. Um, that one is
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 241-936-8
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and then the date of service and total bills.
[CUSTOMER][NEUTRAL] Uh, 3124 through 331 of 24 and $9880.08.
[AGENT][NEUTRAL] Uh oh, the phone broke up. Can you repeat the amount?
[CUSTOMER][NEUTRAL] Uh, yeah, $9880.08.
[AGENT][POSITIVE] Thank you and again just for the call, all the information provided is a verification of benefits.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So I'm actually not showing a claim on file for [PII] um for the date range or um [PII] um on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Alright, I think that is it. If you could just give me a reference number for our call.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right, and I thank you so much for your help today.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.