AccountId: 011433970860
ContactId: 1ce349e1-b007-4783-8a08-177be074edcd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314089 ms
Total Talk Time (AGENT): 149367 ms
Total Talk Time (CUSTOMER): 139474 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/1ce349e1-b007-4783-8a08-177be074edcd_20250131T13:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. I'm calling from the broker's office from my client to see if a claim was received for one of his dependants.
[AGENT][POSITIVE] OK, I can definitely help you with the claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], and the number is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], may I have the member's um policy number?
[CUSTOMER][NEUTRAL] It is 02455568.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I have it here. I just need you to verify the member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII], and his date of birth, hold on one moment, is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, and thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um do you have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] And it's for his dependent son, [PII].
[AGENT][NEUTRAL] Oh, hold on one second, let me see which one [PII] is.
[CUSTOMER][NEUTRAL] He's a dependent born on [PII].
[AGENT][NEUTRAL] [PII], this is #2.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, number 2 just there he is.
[AGENT][NEUTRAL] [PII], total bill is $7,861.
[CUSTOMER][NEUTRAL] He just gave me what the hospital's billing him. His responsibility is 1,778, the provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The hospital.
[AGENT][NEGATIVE] Uh oh, your phone is breaking up. Say that one more time. I missed what you said. I heard provider and then it went out.
[CUSTOMER][NEUTRAL] OK. The provider is billing him 1,778 as his responsibility, and it's for HCA Florida University Hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, this is it. OK, so we did receive the claim, we received it on [PII].
[AGENT][NEGATIVE] The claim has already been processed, uh, but it was denied requesting the explanation of benefits from primary insurance. So it looks like the um provider submitted it, but they didn't submit the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, recently.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But on the
[CUSTOMER][NEUTRAL] So did you
[CUSTOMER][NEUTRAL] Did you request the EOB from them, from?
[AGENT][NEGATIVE] Mhm. On the [PII], we sent them the, you know, like our explanation of benefits after we process and that's what the denial reason, you know, we explained the denial reason and ask them to send it in, but it has not been received yet.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, so you're waiting to hear back from them.
[AGENT][NEUTRAL] Yes, ma'am, and as soon as we receive that explanation of benefits, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] OK. OK, so it was on the [PII] you sent it to them.
[AGENT][NEUTRAL] Mhm. And I have a claim number if you need it.
[CUSTOMER][POSITIVE] OK, please. Thank you.
[AGENT][NEUTRAL] Would that help? OK, you're welcome. It's 355-1551.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3551551
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] A lot of fives in there.
[CUSTOMER][NEUTRAL] OK. OK, so you're waiting to get the EOB from
[AGENT][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] And do you usually, how long does, do they usually respond? I mean, I guess it depends, right?
[AGENT][NEUTRAL] Yeah, it honestly depends. Um, sometimes they send it in, you know, like right after they get the EOB. Sometimes they call uh the providers are hard to talk. They, well, we don't, I don't know how to answer that because sometimes they do it quickly and sometimes they wait, they call us at the end of the year, try to get it all done, so I don't know how to answer that.
[CUSTOMER][NEUTRAL] On the provider.
[CUSTOMER][NEGATIVE] Oh wow. Well, this guy's an attorney, and if they're gonna keep billing him, like he's gonna be pissed cause
[AGENT][NEUTRAL] But you know what,
[CUSTOMER][NEUTRAL] You know, he provided them the information.
[AGENT][NEUTRAL] Oh, they might want to go ahead and do it.
[CUSTOMER][NEUTRAL] Yeah, I know right.
[AGENT][NEUTRAL] Or if he has the explanation of, I don't know if he wants to do the, do the work, um, but if he has the explanation of benefits, um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He doesn't do much work, honey, we do the work for him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, yes, I would either.
[CUSTOMER][NEUTRAL] So, no, but, but anything, what I could do is I'll call the hospital and their billing and just let them know that APL is waiting to pay the claim, but they need for you to send them the EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm for primary.
[CUSTOMER][NEUTRAL] So I, I'll do that. Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah. OK. All righty. Thank you, [PII]. Have a good day.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that's it for today. Thank you.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.