AccountId: 011433970860
ContactId: ca53959e-20d5-4e74-9870-a0e6ef8838fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339929 ms
Total Talk Time (AGENT): 116405 ms
Total Talk Time (CUSTOMER): 117791 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/ca53959e-20d5-4e74-9870-a0e6ef8838fc_20250123T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. It's [PII], and I'm calling to check claim status.
[AGENT][POSITIVE] OK, yeah, I can check on a claim for you and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Call back number [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is 02273052 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, the patient name is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It was for [PII] and the bill charged $1,457.79.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] And I'm sorry, what was the name of the uh provider's office this was with?
[CUSTOMER][NEUTRAL] Uh, its name is Nicholas Children's Hospital. It's also known as Variety Children's Hospital.
[AGENT][NEUTRAL] Got it. OK, thank you for that. So I did find that this claim, uh, looks like this one is actually a duplicate, um, the amount that you gave me, the $1,457.79 is that, uh, before or after major medical?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sims like that was before.
[AGENT][NEUTRAL] OK, do you have them uh balance after?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, after that, yes, uh, it, the balance is $577.73.
[AGENT][NEUTRAL] 577.
[AGENT][NEUTRAL] And 73 cents, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So like, you know, our initial disclaim was processed by the Humana as a primary and, uh, Humana process the claim as a primary and lighter deductible patient deductible amount of $577.73 so which was crossover or which was like bill to the country a bill yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK, so, um, I don't see.
[AGENT][NEUTRAL] I see one claim, but this is for.
[AGENT][NEUTRAL] About $250. That's not it. Give me just a moment.
[CUSTOMER][NEUTRAL] For $250.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] So I did find the original claim is stating that we needed a copy of the EOB from primary.
[CUSTOMER][NEUTRAL] OK, so when was the claim received and processed?
[AGENT][NEUTRAL] Uh, give me just a moment.
[AGENT][NEUTRAL] So this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Do you have the claim number?
[AGENT][NEUTRAL] Yes, it is 3507.
[AGENT][NEUTRAL] 658.
[CUSTOMER][NEUTRAL] And was it for the charge amount, uh, the same charge amount which I provide you or like the 251?
[AGENT][NEUTRAL] This was for the $1,457.79 so we did not receive the primary EOB reflecting that 57773.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim denied for uh primary EOP, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right. And thank you so much for the information for helping me out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And uh I'm so sorry I didn't get your name before. May I have your name once again, please?
[AGENT][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] Is your last name initial, please?
[AGENT][NEUTRAL] Last initial is [PII] Was there anything else I could help you with A?
[CUSTOMER][POSITIVE] Uh, for now that will be all. Thank you so much. I appreciate that. And do we have any colorence number for today's call?
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yeah, thanks for calling APL hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you, have a great day bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Bye take care.