AccountId: 011433970860
ContactId: 149de0ae-c30b-496d-8c4a-64b2378472e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 593520 ms
Total Talk Time (AGENT): 216515 ms
Total Talk Time (CUSTOMER): 445658 ms
Interruptions: 13
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/149de0ae-c30b-496d-8c4a-64b2378472e6_20250422T18:29_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, good afternoon. So, um.
[CUSTOMER][NEUTRAL] Good afternoon. This is from Baptist Hospital of Miami. How are you?
[AGENT][POSITIVE] I'm good. How about you?
[CUSTOMER][NEUTRAL] Good, thanks. I wanted to check uh so on the patient, um, I have a claim to see if you guys have received it and processed it yet, please. Secondary claim.
[AGENT][NEUTRAL] OK, sure, yes, I can assist you with claims and I'm sorry, I didn't quite catch your name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII] from Baptist Hospital, Miami Cancer Institute.
[AGENT][NEUTRAL] Oh [PII], yeah.
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Wait a minute, yeah.
[CUSTOMER][NEUTRAL] Sure, sure, sure. Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you know what? I think I'm looking at a
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just realized this is, this camera, right? Anyway, I'll ask you still. It just looked weird now that I'm looking at it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's OK. What's the policy number? You'll figure it out.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Yes, I know, right? We'll figure it out. So many things every day, we'll figure it out. OK, so, um, yeah, let me go over that side because I know it doesn't look right to me.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, OK. So for this one, and there's all these different insurances, let me just go back here because.
[CUSTOMER][NEGATIVE] No, I can't even find it. OK, hold on, here it is. I have another insurance over there, so I don't know if this is a mistake.
[CUSTOMER][NEGATIVE] Which I think it is, but let me ask you first. Um, OK. So, this one for this, for the American public, it is, um, one second, so, my system is freezing up. Yes, for American is Oscar. No, I don't need Oscar.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] American Public, here it is. 2 I'm sorry, 023-71786.
[AGENT][NEUTRAL] OK, and what's the name and date?
[CUSTOMER][NEUTRAL] MLH, um, yes, uh-huh. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Perfect. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, the date that I'm looking at is [PII] and the amount of the claim was 3,203.
[CUSTOMER][NEUTRAL] So let's see here, cause I see, I don't know, they have you billed as primary. You guys do, you don't do primary. You don't, you're not a major medical. You're right, that's not as much, but let's see what they did.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] Yeah, it doesn't.
[CUSTOMER][NEGATIVE] They had Blue Cross and then they crossed it out and then they deleted Blue Cross and then they send it to you, but you guys don't pay. I, I look at it and I know some, this is not looking right, so anyway.
[AGENT][NEUTRAL] Mm, yeah. It's OK. So it was [PII], correct?
[CUSTOMER][NEUTRAL] [PII], [PII]. Mhm.
[AGENT][NEUTRAL] Just.
[AGENT][NEUTRAL] Hm, I don't have one for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me put this claim really quick first.
[CUSTOMER][NEUTRAL] Let's see what they say about that.
[AGENT][NEUTRAL] Let me make sure that we did not just put the wrong date. We probably typed the wrong date. Let me see, yeah, because I got one for the [PII] and it's the same amount, but it says 3 instead of 3, so let me look at the papers.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, well, you know, now that you mentioned that, well, you know what, so let me check because that could be I have to look in that. I didn't go inside the claim. I was looking at the other screen, um, no, no, it's [PII], OK, we do do that sometimes too like one screen, right, they would have one date and then they go back in there and because the late charges or something after they did the first billing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They would go back in and put it in again and use the date that they put it in, not the original date. So I understand that can, yeah, that could have been it, but that's not the case here so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, yeah, it looks like they just transferred the number, um, but yeah, I do see that the claim is for [PII], but in the system it shows [PII] for some reason, um, but it looks like we're needing the explanation of benefits from the primary insurance to proceed with the processing.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See? Yeah, I told you, yep, yep, yep, you're correct. I don't even, because when I'm looking at it, I'm like, wait a minute. I see when I go back in there, I'm like, what? They, they had Blue Cross Blue Shield, and they deleted it and they send it to you. I'm like, no, that doesn't look right. So, um, yes, you're correct. And um they did have Blue Cross Blue Shield and then they um
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] They deleted it out and they send it to you guys. I said, I'm like, no, that's not correct. So let me see, let me ask you this question. I'm trying to figure it out. What insurance the patient has as primary. If they deleted, deleted Blue Cross. Let me look up here. I see another insurance called um well, Aetna. Well, this is Aetna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me ask you, so, what is the effective date for that policy with you guys? I have to go from there.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so the policy effective date and it looks like we have Cigna as the major medical, um, but the policy effective date was [PII], and this one terminated [PII].
[AGENT][NEUTRAL] Now, based on the information we have on the major medical, we have a Cigna starting on [PII].
[CUSTOMER][NEUTRAL] OK, so they, mhm.
[CUSTOMER][NEUTRAL] Let me write it down. Cigna, starting up with [PII]?
[AGENT][NEUTRAL] That's the major medical.
[AGENT][NEUTRAL] Yeah, mhm.
[CUSTOMER][NEUTRAL] You said 24? OK, hold on. OK, I see. So you not Aetna, not Aetna, Cigna?
[AGENT][NEUTRAL] Yes, 24.
[AGENT][NEUTRAL] Cigna, yes, Cigna.
[CUSTOMER][NEUTRAL] Oh well, another, another, I see this is craziness. I'm showing Aetna there and then I'm showing, um, let me go back here, see if I see which one is this. So you're saying you saw Cigna, OK. I see another insurance called Oscar Health.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So let me go back and ask you a question because you probably had you probably give me the answer quicker than I should get it. So when you see that signal, uh, you said you saw signal which is effective [PII] with no termination date. Did you see uh any termination date on your end so?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, the only thing we can see is the start date and the end date, um, which, um, it's just a year.
[CUSTOMER][NEUTRAL] Is there an end date?
[AGENT][NEUTRAL] Yes, [PII]. Mhm.
[CUSTOMER][NEUTRAL] Is there an end date for that signal?
[CUSTOMER][NEUTRAL] Oh, so wait a minute. So that would be the, but I'm showing, oh Lord have [PII]. I'm showing a different insurance. I'm showing Aetna and then I'm showing Oscar. I don't have a signal. So, um, anyway, that's not your problem to solve, that's our problem.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Whatever it is, you, you cannot do anything with the claim because you exactly that is understandable. You can't do nothing because you need it so now I'm gonna have to figure out which primary this is and so I'm going to be just, I guess you guys whenever you get the claim I don't know, um, is there a claim number just to put it down.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Yes, yes. Uh, the claim number is 357.
[AGENT][NEUTRAL] 8855.
[CUSTOMER][NEUTRAL] 885-5.
[AGENT][NEUTRAL] Yes, 357-885-5.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Person and then I would say um you're effective you're showing the patient APL effective [PII] to to terminate at [PII] which in this case the claim would be paid because it was during this time so I'll just make that now I'm gonna have to face around and find out where which which primary do I need to send it to.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, but, but it looks like it's gonna be Cigna because we do have, yeah, a lot of claims that came through Cigna with the Cigna EOB and it looks like that, yeah, that is the one that the group was using and that's the one that needs to run through and will be the one for the group.
[CUSTOMER][POSITIVE] Oh wow. I do see all these things every day.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So more than likely it's gonna be Cigna.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna go search the system because I didn't see, I see Oscar, I see Aetna, I see APL. I don't see anything else. So I'm gonna have to look around. They do that, they do that, they do that, unfortunately.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] People don't do their jobs, you know, they just, you know, somebody will fix it, which is gonna be me all the time, so no problem.
[AGENT][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you. I know, I know so, you know.
[AGENT][POSITIVE] So you're welcome.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh well thank you so much for your patience with us. Um, I will try to um find out which primary which primary payer this is around this time and then get a bill out to them and then whenever they pay we will send you a a secondary claim if there's any balances, and I'll make a note of the information you just gave me. I appreciate your time and your patience with us. Thank you so much.
[AGENT][POSITIVE] You're welcome Miss [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly, yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. You're welcome, Ms. Honey. You're welcome. Have a good afternoon. Thank you. You too.
[CUSTOMER][POSITIVE] Take care, [PII]. Yes, say hi to everyone over there. Take care. OK. Bye-bye. Thank you. Bye-bye. Bye-bye.
[AGENT][POSITIVE] I will. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome bye bye.