AccountId: 011433970860
ContactId: d057acc5-df76-47dc-8d6b-6664f8a5ff8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341760 ms
Total Talk Time (AGENT): 81510 ms
Total Talk Time (CUSTOMER): 115893 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/d057acc5-df76-47dc-8d6b-6664f8a5ff8b_20250115T18:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Pediatrics Medical Group to check on a claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It is 02049395.
[CUSTOMER][NEUTRAL] M as in mountain, L as in Lima, 7.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, before that, could you just please spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh sorry. Could you please tell that slowly?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, thanks for that. And the patient's name and the date of birth is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that date of birth is for someone else on the policy. That's not [PII]'s date of birth. Is [PII] the patient?
[CUSTOMER][NEUTRAL] Yes, [PII] is the patient.
[AGENT][NEUTRAL] OK. I have a different date of birth for her and I'll need to get that verified before I can proceed.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sorry, the patient is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] With the same date of birth you just gave me.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And you said that you're checking a claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] You're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service in charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is $760 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so we denied it for a copy of the primary insurance explanation of benefits.
[AGENT][NEUTRAL] I show that this claim was received.
[AGENT][NEUTRAL] On [PII] and it was processed on [PII].
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] If I said, if I, if you didn't get it before?
[CUSTOMER][NEUTRAL] Uh, yeah, please provide the claim number.
[AGENT][NEUTRAL] It's 350.
[AGENT][NEUTRAL] 3081.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you told the denial is because of the, you did not receive the primary insurance EOB, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, could you please hold on for just one minute? I'll be back with the details which I have.
[CUSTOMER][NEUTRAL] We get our ages
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][POSITIVE] Thank you so much for your patience. And uh could you please uh let us know that who is the primary insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Humana.
[CUSTOMER][NEUTRAL] OK. If you don't mind, may I get the member ID?
[AGENT][NEUTRAL] For Humana.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We do not have that information. You'll have to contact Humana.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And regarding the effective and term date, yeah, we must contact them, am I right?
[AGENT][NEUTRAL] Any information regarding the primary, you would contact the primary.
[CUSTOMER][NEUTRAL] OK. I got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Could you please provide the call reference number?
[AGENT][NEUTRAL] My, it'll be my name in today's date.
[CUSTOMER][POSITIVE] OK, thanks for that.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][POSITIVE] Uh, no, that's it for the day. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] OK