AccountId: 011433970860
ContactId: f01e61ae-8b7a-4319-b3f2-c05e1a046507
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908919 ms
Total Talk Time (AGENT): 248835 ms
Total Talk Time (CUSTOMER): 244248 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/f01e61ae-8b7a-4319-b3f2-c05e1a046507_20250212T20:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Please spell out your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and last name, sir?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Thank you, [PII]. Myself is. I'm calling from Nicholas Children's Hospital provider office. I'm looking for claiming status.
[AGENT][NEUTRAL] OK. What is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Policy number 12522.
[CUSTOMER][NEUTRAL] 69
[AGENT][NEGATIVE] It's missing one number.
[CUSTOMER][NEUTRAL] 1252269.
[AGENT][NEUTRAL] It's missing one digit. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Yes, just a moment, I'll check again.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes. Uh, OK. 12522.
[CUSTOMER][NEUTRAL] 69.
[AGENT][NEUTRAL] What information do you see on the card?
[CUSTOMER][NEUTRAL] So the number is
[AGENT][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What other information do you see on the ID card?
[CUSTOMER][NEUTRAL] Information and name, member ID.
[AGENT][NEUTRAL] Does it have the patient's name on there?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient member.
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And you said that you are checking a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the policy number and a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service in charge?
[CUSTOMER][NEUTRAL] Date of service is uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Charges $569.09.
[AGENT][NEUTRAL] 5559.
[CUSTOMER][NEUTRAL] 5699.
[AGENT][NEUTRAL] OK, I'm sorry, [PII], give me the total charge again.
[CUSTOMER][NEUTRAL] 569.09.
[AGENT][NEUTRAL] OK, thank you. And you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Still looking.
[AGENT][NEUTRAL] OK, we're needing a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I show that the claim was received.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It's 353-454-9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And give me address for.
[CUSTOMER][NEUTRAL] You'll be submission.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] Mhm. Any other questions?
[CUSTOMER][NEUTRAL] I have, yes, I have 3 more plans, so please give me details.
[AGENT][NEUTRAL] For this patient?
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Patient is different. Give me a call reference number.
[AGENT][NEUTRAL] OK, you can also check your status online at [PII]. And would you like for me to help you set up the account for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The web address is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. Can I move next time?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] 01659366
[AGENT][NEUTRAL] And how many claims do you have for this this policy?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claim statuses do you have for this under this policy number?
[CUSTOMER][NEGATIVE] I have 4 claims, but 1 claim is done. Only 3 claims there.
[AGENT][NEUTRAL] I didn't understand, could you repeat?
[CUSTOMER][NEUTRAL] There is, sorry. No, only 4 claims. On one claim is done.
[CUSTOMER][NEUTRAL] So, uh, let's reclaim.
[CUSTOMER][NEUTRAL] But patient is different, provider is the same.
[AGENT][NEUTRAL] OK, so you have one claim under this policy number that you're trying to do now, or did you say there's 3?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, and what's the date of service?
[CUSTOMER][NEGATIVE] Get of service is uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth and name is [PII].
[AGENT][NEUTRAL] I need a total charge.
[CUSTOMER][NEUTRAL] Total charge is 1500.
[AGENT][NEUTRAL] The total
[CUSTOMER][NEUTRAL] $60.17. Date of service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, did you give me a [PII] date of service?
[CUSTOMER][NEUTRAL] No, date, this is the date of birth, [PII].
[AGENT][NEUTRAL] OK, of [PII]. OK. And I'm sorry, what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[AGENT][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't show a claim on file with that data service.
[CUSTOMER][NEUTRAL] Member is active on that of service?
[AGENT][NEUTRAL] Let me see if she
[AGENT][NEUTRAL] Let me see if she has another policy.
[AGENT][NEUTRAL] The policy is 250.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1804.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We need a copy of the major medical explanation of benefits. Um, I'm showing the claim number is 353275-3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Showing a received date of [PII].
[AGENT][NEUTRAL] And the process date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number 353-2753, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Call the phone number, your, your name, to the date of date.
[AGENT][NEUTRAL] It's the same for the entire call my name and today's date.
[CUSTOMER][NEUTRAL] OK. Can I move next time?
[AGENT][NEUTRAL] Uh, give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. What's the next policy number?
[CUSTOMER][NEUTRAL] Next policy number is 01887405.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm. Data service.
[CUSTOMER][NEUTRAL] [PII] charges $738.22.
[AGENT][NEUTRAL] 738 52.
[CUSTOMER][NEUTRAL] 738 22.
[AGENT][NEUTRAL] 22. OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We need a copy of the major medical explanation of benefits.
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4509.
[AGENT][NEUTRAL] Received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 24
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you have one more?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that number?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah. Policy number is 0, sorry, 2353184.
[AGENT][NEUTRAL] 235-3184.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, your name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, the date of service.
[CUSTOMER][NEUTRAL] That of service is [PII], range of [PII].
[AGENT][NEUTRAL] So, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And for how much?
[CUSTOMER][NEUTRAL] 70572.
[AGENT][NEUTRAL] That's $705.72?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I do not show that data service on file for [PII].
[AGENT][NEUTRAL] Was it recently
[CUSTOMER][NEUTRAL] OK, ma'am is active on that of service?
[AGENT][NEUTRAL] I'm not showing data of service [PII] on file.
[AGENT][NEUTRAL] When was it submitted?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]. Date of service.
[AGENT][NEUTRAL] [PII]. Is that right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't show any May dates of service on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim submitted on [PII].
[AGENT][NEGATIVE] I'm not showing it received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member is active.
[AGENT][NEUTRAL] The policy effective date is [PII]. The policy is active at this time.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Anything else for you?
[CUSTOMER][POSITIVE] Yeah, no, thank you so much. Bye-bye.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.