AccountId: 011433970860
ContactId: 0fa83b5d-385e-4068-a211-60be7e491ffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409230 ms
Total Talk Time (AGENT): 188329 ms
Total Talk Time (CUSTOMER): 155985 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/0fa83b5d-385e-4068-a211-60be7e491ffa_20250320T14:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was calling to follow up on a few claims, um, that were recently sent your way. I got, uh, a couple of explanation of benefits and I just wanted to make sure that I'm clear on what you guys need from me.
[AGENT][POSITIVE] Well, it'd be my pleasure to assist you. Do you happen to have your policy number, please, ma'am?
[CUSTOMER][NEUTRAL] Um, yes, it is.
[CUSTOMER][NEUTRAL] 256 or I don't know if it starts with a 0.02566425.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can you verify your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is your current mailing address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And is this for a claim for [PII]?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I'm showing for the Boca Raton Regional Hospital visit on [PII]. We're needing a copy of your primary insurance showing what was applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how do I do that? Do I go online and?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, who's your primary insurance with?
[CUSTOMER][NEUTRAL] Uh, united.
[AGENT][NEUTRAL] United. So you can go to their website and pull up the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, information for that data service of 1223-24 for Boca Raton Regional Hospital.
[AGENT][NEUTRAL] And click on the EOB or claims details, and that should provide us with what was supplied to the deductible or co-pay or co-insurance for that visit. Then you can upload it on [PII]'s policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] OK, I can go online and upload it. is that pretty self explanatory or is there any?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Thing I should know I've never uploaded anything before.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Let's see, I'm checking to see.
[AGENT][NEUTRAL] And I'm so I'm showing that there is an active portal account.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so you would just save that EOB document in a PDF to your computer and then when you go online where it says upload claim document or upload file, you'll just click that button and upload it on the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll ask you who it's for and you'll just put that it's for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it'll upload that document directly on the policy.
[CUSTOMER][NEUTRAL] Alright, um, and then, so that was for Boca Regional. There were 2 more. Do you need the same thing for those?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Now, in [PII].
[AGENT][NEUTRAL] There was an office visit for health holdings and that is not covered for the office visit.
[AGENT][NEUTRAL] And then I do have 2 claims in line to be processed.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] The, you can check with Huan to see if they applied something to the deductible co-pay or co-insurance for that.
[AGENT][NEUTRAL] Office visit for the service that they performed.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if so, you can upload that EOB showing the deductible co-pay or co-insurance for that service, not for the visit.
[AGENT][NEUTRAL] But for the service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't think that one.
[CUSTOMER][NEUTRAL] I, I'm not sure what that is. I, I, I don't know. The other, it wasn't for an office visit. The other two are also from the hospital, um, their, their one is, uh, physician statement, emergency physician statement, but the date of service was still [PII] and then the other one was the radiology group and that was also service [PII].
[AGENT][NEUTRAL] And we did receive some claims on 318.
[AGENT][NEUTRAL] That have not been processed yet. So those it could be those claims that you're calling in reference to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, do you know those, uh, can you see those or no?
[CUSTOMER][NEUTRAL] At least what those are, I know they're still in process, but at least what they are.
[AGENT][NEUTRAL] Employment.
[AGENT][NEUTRAL] I'm checking that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do have one from, for radiology.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And 14.
[AGENT][NEUTRAL] I have, I have, looks like, and it may be the same claim, but two for from radiology.
[AGENT][NEUTRAL] In line to be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it should only be one, but OK, so that one you just got, OK, and then there should be another one, but OK, the, the thing that I got back from you guys is.
[CUSTOMER][NEUTRAL] It it I think it says that you guys paid that one.
[AGENT][NEUTRAL] It looks like.
[CUSTOMER][POSITIVE] It was, it's I it's yes.
[AGENT][NEUTRAL] OK, that was paid.
[CUSTOMER][NEUTRAL] OK, perfect. So that one's done. So it's just radiology I guess that's being processed and then the other one I will upload the explanation of benefit, I guess I could upload the one for radiology as well, right?
[AGENT][NEUTRAL] You can. I believe that that that was sent with that claim.
[AGENT][NEUTRAL] Cause it looks like that they filed a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it looks like that's all we need.
[CUSTOMER][POSITIVE] All right. I will do that today. I appreciate your help.
[AGENT][POSITIVE] It's my pleasure to assist you. And is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.