AccountId: 011433970860
ContactId: ea144fdf-22fb-47cc-bf5b-aaa2a25bc79e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1377030 ms
Total Talk Time (AGENT): 418546 ms
Total Talk Time (CUSTOMER): 289463 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/ea144fdf-22fb-47cc-bf5b-aaa2a25bc79e_20250513T20:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Myselfuja. I'm calling from Nicholas Children Hospital provider office. I'm looking for claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and Puja, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes. [PII] [PII]. And now your last initial name?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] Now my policy number is uh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yes, policy number is G02440231.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my name is uh
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] May I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes, date of service is [PII]. The end of [PII]. Charges is uh
[CUSTOMER][NEUTRAL] $4,785 6363 cents.
[AGENT][NEUTRAL] 4700.
[CUSTOMER][NEUTRAL] $85.63.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital and office address is uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just the name, it's OK.
[CUSTOMER][NEUTRAL] 3100. OK.
[AGENT][NEUTRAL] Thank you. So I'm showing that the claim was received on, was it 143, received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number is 354.
[AGENT][NEUTRAL] 2143.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Sir, could you repeat that once again?
[AGENT][NEUTRAL] The calendar year max for outpatient benefits has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there is no UV so I'm requesting you please send the UV on fax.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Desktop.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Wait, 513-964. Can you repeat the number again?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 675.
[AGENT][NEUTRAL] OK, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll go ahead and fax this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, I have 4 more claims, so please give me details. Give me a call reference number.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I have 4 more claims, so please, this claim is done.
[CUSTOMER][NEGATIVE] And I have 4 more claims.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 02503123.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Then, so charges is 700.
[CUSTOMER][NEUTRAL] $25.02.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes. Sorry, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351284-4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me address for
[CUSTOMER][NEUTRAL] Sending a UB address.
[AGENT][NEUTRAL] You would like our address? Sure.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Did you need the duplicate um claim number that we received as well?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so we then received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 3571986.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, because it's not a covered loss under the plan, so therefore no amount is payable for the expense, so it's not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the, uh, actually now there is for UB or non-covered under the patient.
[AGENT][NEGATIVE] We denied it as we denied it requesting the explanation of benefits first. You resubmitted the claim and then it was denied with the reason I just gave. It's not a covered. After we received the EOB, we saw that it wasn't a covered charge.
[CUSTOMER][NEUTRAL] Then.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Will you need a copy of the explanation of benefits for all the claims that we go over today?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, do you need the, for this one, do you need a copy of the original or the duplicate case or claim?
[CUSTOMER][NEUTRAL] Interplicate and also both are.
[AGENT][NEUTRAL] So both? OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] 01078915
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And my first name is [PII]. Yeah. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bills?
[CUSTOMER][NEUTRAL] [PII] charges $696.22.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Alright, I'm sure we received this claim on [PII].
[AGENT][NEUTRAL] The claim number is 351-924-6.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Could you repeat that?
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 9246.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, you will be submitted on uh
[CUSTOMER][NEUTRAL] [PII]. You.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, let me see, is this the same?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's just the same, let me see if this is the same claim, hold on one moment.
[AGENT][NEUTRAL] OK, so we haven't received the explanation of benefits for this claim. Um, there is another claim on file, but it's a different total bills.
[CUSTOMER][NEUTRAL] OK. So charges is different, right?
[AGENT][NEUTRAL] So what's
[AGENT][NEUTRAL] Right, so once we receive the explanation of benefits, we'll continue processing this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And just to confirm again, the fax number [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yes, policy number is uh
[CUSTOMER][NEUTRAL] 02500540
[AGENT][NEUTRAL] I'm sorry, can you repeat that policy number for me, please?
[CUSTOMER][NEUTRAL] Yes, 025.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 0540.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My first name is uh
[CUSTOMER][NEUTRAL] Send the phone.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bill.
[CUSTOMER][NEUTRAL] July
[CUSTOMER][NEUTRAL] 9 2024.
[CUSTOMER][NEUTRAL] Charge is $4,261.72.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] OK, and you like both the original and the duplicate?
[AGENT][NEUTRAL] Or the second claim?
[CUSTOMER][NEUTRAL] Both.
[AGENT][NEUTRAL] OK, so the original claim was received on
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim number is 3507984.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we then received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 35490005.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $600.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need any of the payment information?
[CUSTOMER][NEUTRAL] Yes, please. Give me payment information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The checking number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was a single check.
[AGENT][NEUTRAL] It was mailed to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is the correct address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm asking if this is the correct address because the check is.
[CUSTOMER][NEUTRAL] So I'm requesting to please in the UB on fax, sir.
[AGENT][NEUTRAL] Hold on one moment. I was speaking. Can, can you give me a moment? I'm asking if the address is correct because the check is still outstanding. So I'm gonna have to send this over. Can you please confirm if this is the correct mailing address for this check?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I will go ahead and send this back to our representative because we did issue it on.
[AGENT][POSITIVE] [PII] and it is still outstanding. So we'll check on the check and if we need to void this and reissue, we can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the last policy number?
[CUSTOMER][NEUTRAL] Please send the UB on fax.
[AGENT][NEUTRAL] Yes, as I stated, we're sending the EOB for all the claims we go over today.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, next policy number is uh.
[CUSTOMER][NEUTRAL] 252-449-86
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] You said 252-449-86?
[CUSTOMER][NEUTRAL] Yes, 254-498-6.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and you said, OK, so for the policy number 252-44986, that's too many numbers. Can you repeat that again?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 254-498-6.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And the date of birth was [PII]?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes, that's correct. All right, may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Charges $587.01.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for [PII] for [PII].
[AGENT][NEUTRAL] I'm not showing any claims on file for her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Give me a call reference number. Thank you so much.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] Alright, have a good day. Bye bye.