AccountId: 011433970860
ContactId: d79ad539-8b0d-4acb-9bc6-0a9078e655cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453880 ms
Total Talk Time (AGENT): 167924 ms
Total Talk Time (CUSTOMER): 143450 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/d79ad539-8b0d-4acb-9bc6-0a9078e655cc_20250320T22:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Agave Pediatrics. I'm just checking claim status for a patient.
[AGENT][NEUTRAL] OK, Miss [PII], yeah, I can help you with claim status and uh can you please get your callback number, ma'am just in case the call gets disconnected.
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] Thank you ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] I have baby boy [PII]. Date of birth is [PII]. Policyholder is [PII], and the member number is 02153310.
[AGENT][NEUTRAL] OK. Thank you. Let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $790 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, balance remaining after they paid was 181 5 cents.
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a brief hold while I look up this claim for you and I will be right back.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 12 1 24. It's gonna be [PII].
[AGENT][NEUTRAL] 6.
[AGENT][POSITIVE] Thank you, Ms. [PII] for holding for me. So I looked um under uh part one, which is mama.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I did not find a claim on file for the amount that you have given me so then I looked under Baby Boy um which we have is [PII], and I did not find a claim for him either for that data service with the amount that you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now I, well I might have given you the, I might have given you the wrong amount so the full bill amount was the $790 but the patient responsibility after the primary insurance process was 221.05, but the patient paid a $40 co-pay when they came in, so that's why it shows on my end it only showed 18105 because it was taking into consideration that $40 copay. I don't know if that makes a difference.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well
[AGENT][NEUTRAL] It, it could, so let me look under that new amount that you've given me the 22105 and see if I can find.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] 22105 yeah.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mm, no.
[AGENT][NEUTRAL] I'm not finding it under mama. Let me look under.
[AGENT][NEGATIVE] No, nothing close to that amount under baby either, and the two claims that I have for them on that date of service have already been paid, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now it looks like it was
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Let me see I just happened to look to see.
[CUSTOMER][NEUTRAL] Well, I show that they, uh, it was mailed on [PII].
[CUSTOMER][NEUTRAL] So, um, almost 30 days ago.
[AGENT][NEUTRAL] Yeah, that's been a while, so.
[AGENT][NEUTRAL] Let me just look and see if there's anything.
[AGENT][NEUTRAL] From your facility at all? No, that's not your facility.
[AGENT][NEUTRAL] And then look, let me look under mama to see if it's under your facility for her.
[AGENT][NEUTRAL] No, neither one of those are.
[AGENT][NEUTRAL] Yours. So, yeah, I'm not finding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have a mailing address [PII].
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, do you have a fax number at all for claims?
[AGENT][NEUTRAL] Yes ma'am, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we also have a pay ID number if you wanted to send it electronically to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, did you say that was 87?
[AGENT][NEUTRAL] And that payer ID number.
[CUSTOMER][NEUTRAL] Sorry, [PII]?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][POSITIVE] OK perfect and the payer ID.
[CUSTOMER][NEUTRAL] Mm, come on computer and what was that?
[AGENT][NEUTRAL] Is is 6.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 60801 American Public Life Insurance and do you know if that's allowed through um Trietta?
[CUSTOMER][NEUTRAL] As the clearing house because it does come up under Trieto it just gives me a different mailing address.
[CUSTOMER][NEUTRAL] Give me a [PII].
[AGENT][NEGATIVE] OK, the [PII] is no longer a good ad.
[CUSTOMER][NEUTRAL] OK, so they just need to update their PO box.
[AGENT][NEUTRAL] And Trezeto is not something.
[CUSTOMER][NEUTRAL] Maybe I'll fax it just because I know it'll get there at least.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate your help [PII] have a great day.
[AGENT][POSITIVE] You're so welcome, Miss um a wonderful day too, and thank you so much for.