AccountId: 011433970860
ContactId: ef81435d-96d5-475d-9d67-3bda016a86be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 673950 ms
Total Talk Time (AGENT): 206769 ms
Total Talk Time (CUSTOMER): 133969 ms
Interruptions: 0
Overall Sentiment: AGENT=2.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/ef81435d-96d5-475d-9d67-3bda016a86be_20250129T16:02_UTC.wav
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[AGENT][POSITIVE] Hi, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on behalf of Nicholas Children's Hospital. I have a few claims to get a status of, please.
[AGENT][POSITIVE] OK, Miss [PII], I'd love to help you with claim status today. Do you mind if I go ahead and snag a good callback number from you as well?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] Thank you so much. And what is the policy number we want to look at today?
[CUSTOMER][NEUTRAL] Um, the first one that I have is.
[CUSTOMER][NEUTRAL] Where did it go? There it is 145857.
[CUSTOMER][NEUTRAL] 5 M as in Mike, L as in Lima, and 7.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 1 2nd to get that pulled up.
[AGENT][NEUTRAL] Sorry
[AGENT][POSITIVE] There it is awesome thank you so much for your patience and would you be able to verify your member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, it is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect. I do see [PII] here and is there a particular claim number you're wanting to look at, or did you want me to search by data service?
[CUSTOMER][NEUTRAL] Um, data service please.
[AGENT][NEUTRAL] Alright, and what is the data service we wanna look at today?
[CUSTOMER][NEUTRAL] Um, 8:31 of 24.
[AGENT][NEUTRAL] And may I have that billed amount, please?
[CUSTOMER][NEUTRAL] Yes, it is $3670.03.
[AGENT][NEUTRAL] and then that total after primary.
[CUSTOMER][NEUTRAL] Total after primary looks like.
[CUSTOMER][NEGATIVE] Sorry, my system's slow.
[CUSTOMER][NEUTRAL] Uh, $1,473.
[AGENT][POSITIVE] Thank you, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Give me a second, I just have a couple to check on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Sorry, and then just one more to check on thank you so much for your patience.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright
[AGENT][POSITIVE] I greatly appreciate that patience. I was able to find your claim. I
[AGENT][NEUTRAL] Have your claim number listed with us is 3512531.
[AGENT][NEUTRAL] And I do see that we received that claim on [PII]. It looks like we processed it on [PII], and it looks like the claim was denied just requesting it, um, an explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I do have the fax number and is that would can we fax it just with like attention to um.
[CUSTOMER][NEUTRAL] Claims
[AGENT][POSITIVE] Yes, absolutely you can fax that attention to claims and then we would be able to um reconsider that for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good on that one.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Perfect. I am ready for that next one when you are.
[CUSTOMER][NEUTRAL] OK, the next member ID that I have is 0229.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8880.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Wonderful, Miss [PII], and if you could verify this member's first and last name and date of birth as well.
[CUSTOMER][NEUTRAL] Um, [PII], date of birth is [PII].
[AGENT][POSITIVE] Perfect and I do see Ms. [PII] here and.
[AGENT][NEUTRAL] Likewise we wanna search by data service for her, is that correct?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][POSITIVE] Wonderful and what is that data service, ma'am?
[CUSTOMER][NEUTRAL] Uh, 627 of 24.
[AGENT][NEUTRAL] One second and that bill amount.
[CUSTOMER][NEUTRAL] Uh, looks like $18,309.28.
[AGENT][POSITIVE] Wonderful and then.
[AGENT][NEUTRAL] Let me pull that one up for you.
[AGENT][NEUTRAL] Alrighty, so I was able to find that claim as well. It looks like your claim number is 354-7109. I show we received the claim on [PII], and we processed the claim on [PII], and I show that that claim was denied. It says that the maximum benefit payable for the state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And so that list um.
[CUSTOMER][NEUTRAL] That that amount to the member.
[AGENT][NEUTRAL] Because we're a supplemental policy, APL cannot determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, that will be all on that one.
[AGENT][POSITIVE] Perfect and I'm ready for that next one when you are.
[CUSTOMER][NEUTRAL] OK, the next one is 02430725 M M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, Miss [PII], thank you, and if you could verify that member's first and last name and date of birth as well.
[CUSTOMER][NEUTRAL] OK, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, I do see [PII] here and.
[AGENT][NEUTRAL] What is the date of service for [PII] we wanna look at today?
[CUSTOMER][NEUTRAL] Uh, [PII] through [PII].
[AGENT][NEUTRAL] [PII] 2024 you said?
[CUSTOMER][NEUTRAL] Yes, through [PII].
[AGENT][NEUTRAL] Alright and.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] And what was that built amount?
[CUSTOMER][NEUTRAL] Um, billing amount is $7,574.01.
[AGENT][NEUTRAL] Alright, Ms. [PII], I am really sorry, but I am not showing any claim on file for that date of service or that billed amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we do not have a timely filing limit. You're welcome to submit that at any time.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, um, I will get that submitted back over then and I think that's all I need today.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That was it today, Miss [PII]. Perfect. Well, thank you so much for calling APL. I hope you have a fabulous week.
[CUSTOMER][POSITIVE] Alright you too thank you so much.
[AGENT][POSITIVE] My pleasure, thank you.