AccountId: 011433970860
ContactId: e01bc228-3c89-4ca4-99e7-5e2e6552d667
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485989 ms
Total Talk Time (AGENT): 212466 ms
Total Talk Time (CUSTOMER): 126407 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e01bc228-3c89-4ca4-99e7-5e2e6552d667_20250610T13:47_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling um to know the status of my claim. I had faxed an EOB over about 2 weeks ago, so I wanted to know if you received it.
[AGENT][NEUTRAL] OK, [PII], so you're wanting to see if something you submitted for a claim has been received, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] My policy is 01813054.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please to get your policy information pulled up. And then [PII], I will have to verify several things with you first for security. So just one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, [PII], so first off, any information provided today will be a verification of benefits and not a guarantee of payment. So if you could first please verify the subscriber's name and date of birth and then your last name and your date of birth.
[CUSTOMER][NEUTRAL] Subscriber um is [PII]. Birthday is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my, my name is [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. Your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the phone number that we would have on file for um Mr. [PII], please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying the information. All right, and what date of service am I looking for for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] I have a reference number. I don't know if that would help you. I also have a claim number.
[CUSTOMER][NEUTRAL] Um, but the date of service is [PII].
[AGENT][POSITIVE] OK, so thank you. Give me just a couple of moments.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, Jet ski. So it's [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so now for those two dates of service, I don't have a claim on file. You said that you have a claim number?
[CUSTOMER][POSITIVE] I do, yes.
[AGENT][NEUTRAL] What is that claim number?
[CUSTOMER][NEGATIVE] And I had received, I had received feedback that it was denied, so then that's when I faxed over the what they asked for, right, which was the EOB with the itemized bill with the codes and all that stuff.
[AGENT][NEUTRAL] OK, now, is the claim for you, [PII], or for your husband?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's for my daughter.
[AGENT][NEUTRAL] Oh, OK. And what is your daughter's name and date of birth because I was looking on your profile.
[CUSTOMER][NEUTRAL] Oh, no, no, I'm sorry. It's for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Just give me a moment to read you some information please, [PII].
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so I show [PII], the only, OK, so I see one claim that was received for
[AGENT][NEUTRAL] 11:25 2023 and give me a moment to look. Now, that was the one that was received back in the end of March.
[AGENT][NEUTRAL] And let me just look at the remarks on that.
[CUSTOMER][NEUTRAL] Yeah, I think that's it was denied and so then that's when I faxed over the, the stuff they asked for the itemized bill and all that stuff, and I wanted to know the status if you had received it because I faxed it over about 2 weeks ago.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so let me look, so you already know the remarks on that one because that was where we were needing the detailed explanation of benefits, OK.
[AGENT][NEUTRAL] And the only other claim that I see on file was we received it on [PII]. Now this is showing for data service [PII], OK.
[AGENT][NEUTRAL] For Nicholas Children's Hospital, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so on one of the codes that were submitted for that data service, there is a benefit in the amount of $300,350 that is scheduled to go through our processing tonight. The other code that was on there is showing.
[AGENT][NEUTRAL] As denied because it states that your major medical coverage provided full benefits, no benefits were payable. So, yes, and there is a $350 benefit that should process.
[AGENT][NEUTRAL] Tonight.
[CUSTOMER][NEUTRAL] Tonight, OK. All right. So 350 was the only thing that the secondary APL covered.
[AGENT][NEUTRAL] it should get.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And that is showing for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. All right. So, um, uh, then I guess you'll cut the check and send it to [PII] and then they'll refund me the what I paid, correct?
[AGENT][NEUTRAL] Actually, the, well, actually the check will be, um, it's gonna be issued to you all since you are the ones who file the claim.
[CUSTOMER][POSITIVE] Oh, to me, OK, great.
[AGENT][NEUTRAL] Correct. Yes, ma'am. Uh-huh. OK. Well, is there, oh, absolutely. Is there anything else that I can help you with this morning, Ms. [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[CUSTOMER][POSITIVE] No, that's it. Thank you for your help. You've been helpful.
[AGENT][POSITIVE] Well, well, you're very welcome. It's my pleasure in speaking to you and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.