AccountId: 011433970860
ContactId: cc38c40e-88c5-41b0-be2f-240b4d7d33ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1193750 ms
Total Talk Time (AGENT): 259007 ms
Total Talk Time (CUSTOMER): 296396 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/cc38c40e-88c5-41b0-be2f-240b4d7d33ac_20250114T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII], and I'm calling from provider office, and I want to know about claim information. Could you please help me also for that?
[AGENT][NEUTRAL] Yes, [PII], I can help you with claim information. Can you please give me your call back number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. And it is the direct line.
[AGENT][POSITIVE] OK, thank you so much. And then what is the um patient's name?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[AGENT][NEUTRAL] OK, and then what is the date of birth please for Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, the date of birth of this member is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the policy number, please?
[CUSTOMER][NEUTRAL] It is 02473484 M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you, let me pull that policy in real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service for [PII]?
[CUSTOMER][NEUTRAL] Uh, the date of service of this is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the charge amount?
[CUSTOMER][NEUTRAL] It is 1,364 and 15 cents.
[AGENT][NEUTRAL] Thank you and then what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, sorry for that. I don't know about it.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It is Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Huh
[AGENT][NEUTRAL] 95
[AGENT][NEUTRAL] 6
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 567
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Hi, Ms. [PII]. This is [PII] back with you again. I am not showing that the claim has been submitted for Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. Just give me a second. I just double check in my system first.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] American of life.
[CUSTOMER][NEUTRAL] OK. Yeah, it is uh
[CUSTOMER][NEUTRAL] The name of the facility for this is West Bird Outpatient Center, Nicholas Children's Hospital, right?
[AGENT][NEUTRAL] I'm still not finding it under that name.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. So may I provide you the uh member, oh sorry, sorry, uh, the NPI for this member? Because the uh patient um NPI is different for this.
[AGENT][NEUTRAL] What is it that you're wanting to provide to me, ma'am?
[CUSTOMER][NEUTRAL] Uh, it was different for Nicholas Children's Hospital, but for this claim, uh, the West bird outpatient Saint Nicholas Children's Hospital, it is 173056-1481.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still not finding it under Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So, the claim is not on file for this, right?
[AGENT][NEUTRAL] Not for Nicholas Children's Hospital.
[CUSTOMER][POSITIVE] OK. OK, no problem. Thank you so much for this information, sir. May I have the call reference number for this?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, sorry, actually, I have like 2 more claims. So could you please help me also for those claims?
[AGENT][NEUTRAL] Let me put you on a hold and put my notes in and then we'll move on to the next one, OK?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, Miss [PII]. What is the next patient's name?
[CUSTOMER][NEUTRAL] OK. It is [PII] and the date of birth for this member is, it is [PII].
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] Um, the policy number is 02107062 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, let me pull in the policy.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] It is 389 69 cents.
[AGENT][NEUTRAL] And then the charge after the primary insurance paid their part.
[CUSTOMER][NEUTRAL] Uh, I don't know about that. Sorry for that.
[AGENT][NEUTRAL] OK, and is it still for Nicholas Children's Hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold. I'm gonna look that up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me Miss [PII]. So for on I did find a claim. The claim number is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 52.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 590.
[AGENT][NEUTRAL] We received the claim on [PII] of 24.
[AGENT][NEUTRAL] So 1024 2024.
[CUSTOMER][NEUTRAL] Uh, actually, your voice is, uh, uh, hello? Hello, sorry. Hello.
[AGENT][NEUTRAL] Hello
[CUSTOMER][NEGATIVE] Actually, your voice is breaking, breaking up.
[AGENT][NEUTRAL] Hello, hear you.
[CUSTOMER][NEUTRAL] Actually, your voice is breaking up. So could you please repeat uh the received date? It is [PII] after that?
[AGENT][NEUTRAL] We received [PII] of.
[AGENT][NEUTRAL] We processed it on [PII].
[AGENT][NEGATIVE] I'm more denied because we need the EOB for the primary insurance.
[CUSTOMER][NEUTRAL] OK. And could you please repeat the claim number because your voice um broke up that time. It is 3521.
[AGENT][NEUTRAL] 3,521,590
[CUSTOMER][NEUTRAL] 90. OK, sorry. Thank you so much for this information. So may I have the call reference number for this or it is the same, your name or date?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] It's the same. Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So may I provide, uh, could you please provide me the last member information?
[AGENT][NEUTRAL] Yes, ma'am. What is the um last member's name?
[CUSTOMER][POSITIVE] Mhm. Thank you so much. It is uh [PII] and the date of birth of this is [PII].
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] It is 1475935 M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. Let me pull that policy up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] The date of service for this is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] The charge amount is
[CUSTOMER][NEUTRAL] Just give me a second. It is 696 and 22 cents.
[AGENT][NEUTRAL] And then what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, sorry for that. I don't know about that.
[AGENT][NEUTRAL] OK, and then is it for the same facility, Nicholas Children's Hospital?
[CUSTOMER][NEUTRAL] Uh, no, uh, no, actually, there is mentioning West but outpatient Saint Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, I'm going to put you on a brief hold. I'm gonna look that claim up for you and I'll be right back, Miss [PII].
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK thank you so much Miss [PII]. This is [PII] back with you again.
[CUSTOMER][NEUTRAL] yeah
[AGENT][NEGATIVE] Looking for data service [PII], there is not a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So do you have any member um coverage information? What is the effective or term in something?
[AGENT][NEUTRAL] The effective date of the policy is [PII] and then and the policy lapsed on [PII]. Let me see if she has another policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She does. Let me look on the, let me put you on hold and let me look on this other policy. She does have an active policy.
[AGENT][NEUTRAL] Let me give you that policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 246-577-3.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm gonna put you on hold because I'm gonna look and see if it's on this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you, Ms. [PII]. I did find it.
[AGENT][NEUTRAL] Uh, the claim number, the claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1611.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was reported on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied because we need the explanation of benefits from the primary insurance.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much for this information, [PII], and for your help. Thank you so much and have a great day.
[AGENT][POSITIVE] You're welcome you have a great too, Miss [PII]. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.