AccountId: 011433970860
ContactId: f0fb54ad-47ea-4013-ab43-0d2437c2b394
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466410 ms
Total Talk Time (AGENT): 117723 ms
Total Talk Time (CUSTOMER): 152785 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/f0fb54ad-47ea-4013-ab43-0d2437c2b394_20250403T18:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], and I'm calling from Nicola Children's Hospital. I want to know the claim status of this member.
[AGENT][NEUTRAL] Uh, yes, sir. I can help you, um, with, and you wanted the eligibility of the members.
[CUSTOMER][NEUTRAL] Uh, no, I want the claim status.
[AGENT][NEUTRAL] Are you there sir?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] OK, claim status, and can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Last initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[AGENT][POSITIVE] Thank you very much for giving me that information. I can help, help you with claim status. Can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, the patient's name is uh [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] The policy number, the member ID for this one is
[CUSTOMER][NEUTRAL] 02440231 M. [PII].
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show to [PII]. I've got her policy pulled up. What is the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service for this one is [PII]. And the bill amount is $3670.03.
[AGENT][NEUTRAL] Thank you. And then can I please have the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, that, uh, just give me a moment. There's 1000.
[CUSTOMER][NEUTRAL] $488.76.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, Nicola Children's Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. I, I looked on data service for [PII], and I do not find a claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, we have sent, we have billed the claim on our software on [PII].
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] So you don't have any updated status for this one, right? There is no claim on file according to you, right?
[AGENT][NEGATIVE] No, not for the amount that you have given me.
[CUSTOMER][NEUTRAL] Or do you have another claims uh with under different amount?
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Under our facility.
[AGENT][NEUTRAL] Yes, let me look, sir.
[CUSTOMER][NEUTRAL] Because as per the previous, uh, this one, the OK.
[CUSTOMER][NEUTRAL] The patient responsibility was transferred to uh this uh secondary insurance.
[CUSTOMER][NEUTRAL] Uh, of this much amount.
[CUSTOMER][NEUTRAL] And we have uh billed the claims to secondary. OK. There is no claim on file, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Not not for the amount that you gave me.
[CUSTOMER][NEUTRAL] If I have to resubmit the claims, may I have the mailing address or the payer ID where I can resubmit the claim?
[AGENT][NEUTRAL] Yes, sir. The payer ID is 60801.
[AGENT][NEUTRAL] And the address is [PII].
[AGENT][NEUTRAL] And that's in [PII]?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And what will be the time the viding limit for this one?
[AGENT][NEGATIVE] We don't have a timely filing limit.
[CUSTOMER][NEUTRAL] OK, there, there is no limit for the timely filing, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh may I have the eligibility for this one?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] The effective date of the policy is [PII].
[AGENT][NEUTRAL] And the policy is still active.
[CUSTOMER][NEUTRAL] And uh may I have the call reference number for this one?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII], for the information and thank you for assisting me. Have a nice day. Take care, bye for now.
[AGENT][POSITIVE] OK, thank you, [PII]. You have a great day too, and thanks for calling APL. Bye-bye, sir.