AccountId: 011433970860
ContactId: d3323834-32da-4324-a937-27772079f3ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1025800 ms
Total Talk Time (AGENT): 198725 ms
Total Talk Time (CUSTOMER): 138955 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/d3323834-32da-4324-a937-27772079f3ee_20250210T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Can you please help me with the claim?
[AGENT][NEUTRAL] Sure, I can assist you with claims and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII]. And what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I have the member ID which is uh.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] That's not a policy number, that is the payer ID.
[AGENT][NEUTRAL] Do you have any other numbers besides that one?
[CUSTOMER][NEUTRAL] No. Could you please check with the member's name if possible?
[AGENT][NEUTRAL] Um, sure. What's the spelling of the last name?
[CUSTOMER][NEUTRAL] It is [PII] [PII] [PII], [PII], [PII] [PII] [PII].
[AGENT][NEUTRAL] OK, and the spelling of your first name?
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The spelling of the first name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. One moment, let me see if I can find it.
[AGENT][NEUTRAL] What is uh the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] is the date of birth?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is he the main holder of the policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you know what state is Mr. [PII] at?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The state?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, let me try this one then one moment.
[AGENT][NEUTRAL] OK, so he's a dependent of the policy.
[AGENT][NEUTRAL] Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] D of service, [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $569.09.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, let me pull this EOB. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK, um, it looks like we received the claim on [PII] and process on [PII].
[AGENT][NEUTRAL] And we're needing the explanation of benefits from the primary insurance to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK. And what is the claim number?
[AGENT][NEUTRAL] That is 353-7140.
[CUSTOMER][NEUTRAL] OK. And could you please also provide me the correct number ID of this patient?
[AGENT][NEUTRAL] Sure, the policy number is 2503356.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] I have 2 more claims for a different number. Is it possible to provide me that? Yes.
[AGENT][NEUTRAL] If you remember?
[AGENT][NEUTRAL] OK, uh yes, I just need to make a note on this 11 moment.
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEUTRAL] All right. And what is the next policy number?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 657
[CUSTOMER][NEUTRAL] 65
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you. One moment, let me pull this policy.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service, [PII] and bill amount $1,946.23.
[AGENT][NEUTRAL] OK, let me see if I can find it.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, sounds like we have.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We also need the primary explanation of benefits. Um, now this one was received [PII] and processed [PII].
[CUSTOMER][NEUTRAL] OK. And what is the claim number?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It's 351-216-5.
[CUSTOMER][NEUTRAL] 351-216-5
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for this one also.
[AGENT][NEUTRAL] You welcome one moment.
[AGENT][NEUTRAL] We finalize the note.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 730
[CUSTOMER][NEUTRAL] 52 ML 8.
[AGENT][NEUTRAL] And ask the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $719.98.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said it was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII], OK. [PII], right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, we received the claim [PII], processed [PII], and we need the primary explanation of benefits.
[AGENT][NEUTRAL] The claim number is 3511943.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, well, thank you for calling APL. Have a good day.