AccountId: 011433970860
ContactId: c68d1a5e-b8df-4216-958e-eff00128c269
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 849390 ms
Total Talk Time (AGENT): 176360 ms
Total Talk Time (CUSTOMER): 226783 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/2025/04/14/c68d1a5e-b8df-4216-958e-eff00128c269_20250414T19:46_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and I'm calling of Nicola Children's Hospital, and I want to claim status.
[AGENT][NEUTRAL] OK. And what was your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], OK, and I can help you with claim status. Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]. Could you please spell your name, what is your name?
[AGENT][NEUTRAL] [PII], and that's [PII]
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, policy number is.
[CUSTOMER][NEUTRAL] Let let me check the insurance card.
[CUSTOMER][NEUTRAL] 01423355 M Mary L Lima number 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] And the patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] And the date of services, uh, [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] And total charges $700.97.
[AGENT][NEUTRAL] OK, looks like we got that claim 3 times. Let me see what which one is.
[AGENT][NEUTRAL] Status.
[AGENT][NEUTRAL] OK, it looks like we got, we need an explanation of benefits. Let me see if you received that.
[AGENT][NEUTRAL] 354
[AGENT][NEUTRAL] Um, I don't show that we received the explanation of benefits, however, we received the claim 3 times.
[CUSTOMER][NEUTRAL] Yeah, actually, uh, you mean Kili was for, uh, pri UV.
[CUSTOMER][NEUTRAL] Correct?
[AGENT][NEUTRAL] Yes, yes, the explanation of benefits from the primary carrier.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, but we submit the um.
[CUSTOMER][NEUTRAL] Claim with attach the primary UV luggage, primary uh UV and made, uh, we submit the three times.
[CUSTOMER][NEUTRAL] Uh, like it's paper claim.
[CUSTOMER][NEUTRAL] On the mailing address is [PII] Ok Ok [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, let me see.
[AGENT][NEUTRAL] Um, we got a, let's see.
[AGENT][NEUTRAL] It looks like a billing printout.
[AGENT][NEUTRAL] From the hospital?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But we, we don't have the actual primary explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] It's like a printout from the hospital.
[CUSTOMER][NEUTRAL] Uh, mailing address.
[AGENT][NEUTRAL] Mailing address, yes, the one that you.
[CUSTOMER][NEUTRAL] Steph mailing address is correct?
[AGENT][POSITIVE] The mailing address is correct, yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. OK, no worry. So now we submit, we submit the claim?
[CUSTOMER][NEUTRAL] Correct?
[AGENT][NEUTRAL] Yes, well, well, we, you don't have to resubmit the claim. We just need the primary explanation of benefits, not a billing statement or bill type.
[CUSTOMER][NEUTRAL] OK. Uh, claim number is 3506017 and receive once it [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Uh, reference number is?
[AGENT][NEUTRAL] It's my name, [PII], first initial to [PII] name, [PII], and today's date.
[CUSTOMER][POSITIVE] [PII]. OK, no worries. Thank you.
[CUSTOMER][NEUTRAL] OK. [PII], let's move for another claim.
[AGENT][NEUTRAL] OK. Hold on one moment.
[AGENT][NEUTRAL] for the same patient?
[CUSTOMER][NEUTRAL] A different patient.
[AGENT][NEUTRAL] OK, the policy number?
[CUSTOMER][NEUTRAL] And the policy number is
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] 022 03089 ML 8.
[AGENT][NEUTRAL] OK, what is 022 03 what?
[CUSTOMER][NEUTRAL] 03089 ML 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] A patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] [PII], total charges $756.81.
[AGENT][NEUTRAL] OK, this claim was submitted 3 times, and let me see which.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Claim number is 351-6957. Correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] Need a copy of the explanation of benefits, not a printout.
[AGENT][NEUTRAL] It needs to be the actual EOB from the primary.
[CUSTOMER][NEUTRAL] Uh, for them to be.
[CUSTOMER][POSITIVE] OK, no worry.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] So let's move for another thing.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and the ID number?
[CUSTOMER][NEUTRAL] Sure. And the member ID age?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 203
[CUSTOMER][NEUTRAL] 089 ML 8.
[AGENT][NEUTRAL] OK, so it's the same patient?
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] Uh, but the, uh,
[CUSTOMER][NEUTRAL] Date of service is different.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] To [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. But claim was uh actually this is a recurring account and the claim.
[CUSTOMER][NEUTRAL] was billed on date of service, [PII] with bill amount $705.72.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] I need an explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, may I have the claim number?
[AGENT][NEUTRAL] 3542083.
[CUSTOMER][NEUTRAL] Uh, when was that received?
[CUSTOMER][NEUTRAL] Received it?
[AGENT][NEUTRAL] Received date was [PII], or denied 12-17-2024.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] With MD you will be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have any other data service?
[CUSTOMER][NEUTRAL] So let's move for another cream.
[AGENT][NEUTRAL] The different patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] And the policy number is
[CUSTOMER][NEUTRAL] Uh, give me one second. 02465765 ML 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] And the patient name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Total charges $12,200.43.
[AGENT][NEUTRAL] build
[AGENT][NEUTRAL] OK, looks like we received that twice and.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Claim number 357-2146.
[AGENT][NEUTRAL] Uh, we received the claim.
[CUSTOMER][NEUTRAL] On the received date?
[AGENT][NEUTRAL] Um, that was.
[AGENT][NEUTRAL] proceed 33 2025 process 36 2025.
[AGENT][NEUTRAL] And it looks like the EOB submitted.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, it does not list the amounts applied to the deductible co-pay or co-insurance, so we need a more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Required primary UV.
[CUSTOMER][NEUTRAL] That is correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So let's move for another thing.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][POSITIVE] OK, no worries. Thank you so much. It's definitely nothing real. Thank you so much. Bye-bye. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APL you as well.