AccountId: 011433970860
ContactId: f5d42bd6-8c03-46e1-ba10-fc6d0fd71b32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1096420 ms
Total Talk Time (AGENT): 222197 ms
Total Talk Time (CUSTOMER): 204461 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/f5d42bd6-8c03-46e1-ba10-fc6d0fd71b32_20250206T21:49_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling from Nicola Children Hospital provider office. I'm looking for claim status.
[AGENT][POSITIVE] OK, sure, I can assist you with that. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] First of all, give me your name.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] Thank you, sir. Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility or provider you're calling from?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. Policy number 1640658.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull this information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[AGENT][NEUTRAL] OK. And what is your date of birth?
[CUSTOMER][NEUTRAL] Date of birth is um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII]. OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII]. Date of service is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Arrange [PII].
[CUSTOMER][NEUTRAL] Charges
[CUSTOMER][NEUTRAL] $1,444.33.
[AGENT][NEUTRAL] OK, so it's [PII] and it's for $1,044.33.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] In one moment.
[AGENT][NEUTRAL] OK, let me pull this one moment.
[CUSTOMER][NEGATIVE] Actually, I'm asking uh how to uh find out the portal claim status because several time I tried, but uh I'm not, I'm unable to find out.
[AGENT][NEUTRAL] Yeah, and that's why I'm looking for it for you, OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. Um, the reason for the denial is one moment.
[AGENT][NEUTRAL] A gynecology, speech, or occupational therapy are not covered under this policy.
[CUSTOMER][NEUTRAL] Could you repeat that?
[AGENT][NEUTRAL] Yes, ktology, speech or occupational therapy are not cover benefits under this policy.
[CUSTOMER][NEUTRAL] Patient policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there is no UV, so please.
[AGENT][NEUTRAL] Mhm, yeah, um.
[CUSTOMER][NEUTRAL] Then that you'll be on set.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Like somebody.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yeah, 40504.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII] 27.
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, so that's [PII], right?
[CUSTOMER][POSITIVE] Got it, yeah, got it.
[AGENT][NEUTRAL] OK, and it's gonna be under under your attention.
[CUSTOMER][NEUTRAL] Yeah, attention is uh Nicholas and receive the pooja P double [PII] J.
[AGENT][NEUTRAL] I'm sorry, can you spell your name one more time?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment, let me send this out to you while I got you on the line. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. OK, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, give me claim number.
[AGENT][NEUTRAL] Yes, that's 351-714-2.
[CUSTOMER][NEUTRAL] And I have 2 more claims, so please give me details.
[AGENT][NEUTRAL] Is it gonna be the same um patient or a different patient?
[CUSTOMER][NEUTRAL] Patient different provider the same give me call reference number.
[AGENT][NEGATIVE] There's no reference numbers you can use my name in today's name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][POSITIVE] I'm ready for the next one, yes.
[CUSTOMER][NEUTRAL] Yeah, policy number is 0161.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 0161156
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Um, there was too many numbers.
[AGENT][NEUTRAL] Can you repeat the number one more time?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] Yes. 01611565.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] and date of birth is [PII].
[AGENT][NEUTRAL] right.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Charges $1,441.
[CUSTOMER][NEUTRAL] 16 cents.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like let's see.
[AGENT][NEUTRAL] We received the claim [PII] and we processed [PII] and we need the primary EOB from the major medical.
[CUSTOMER][NEUTRAL] Mhm. They not for primary, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Give me claim number.
[AGENT][NEUTRAL] That is 3542113.
[CUSTOMER][NEUTRAL] Sorry, 354.
[AGENT][NEUTRAL] 2113.
[CUSTOMER][NEUTRAL] 0 113. OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Only one plane. So, are you ready?
[AGENT][NEUTRAL] No, one moment. Let me finalize the note.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 02265
[CUSTOMER][NEUTRAL] 984.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient date of birth is [PII].
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth, sorry, date of birth is [PII].
[CUSTOMER][NEUTRAL] Charge is $4,926.54.
[AGENT][NEUTRAL] All right. OK, let me see if I can find it.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, it looks like we received the claim [PII] and processed [PII], and it looks like we need the primary EOB to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK, give me the number.
[AGENT][NEUTRAL] That is 354-57.
[AGENT][NEUTRAL] 43.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK well thank you for calling APL. Have a good day.