AccountId: 011433970860
ContactId: 3233c39b-9964-4693-8481-0a937276bae8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563080 ms
Total Talk Time (AGENT): 212740 ms
Total Talk Time (CUSTOMER): 212260 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/3233c39b-9964-4693-8481-0a937276bae8_20250602T14:36_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] Hi, [PII]. Good morning. My name is [PII] and I'm with Boca Raton Regional Hospital. Medical claim status, please?
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, let me pull it up.
[CUSTOMER][NEUTRAL] That is 02020426 ML 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII], [PII].
[AGENT][NEUTRAL] And the policy number was 2020426.
[CUSTOMER][NEUTRAL] 02020426 ML 7.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] This is pulling up a different member.
[AGENT][NEUTRAL] OK, can you repeat it one more time because it's pulling up a different member.
[AGENT][NEUTRAL] I just want to make sure I'm typing it right.
[CUSTOMER][NEUTRAL] Sure. 0202. OK, 02020426 ML 7.
[AGENT][NEUTRAL] Yeah, this is bringing up a different member. Um,
[AGENT][NEUTRAL] Let me see if she's.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Yeah, it's bringing up a totally different member and it's
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] [PII], yeah. Do you have her full social?
[CUSTOMER][NEUTRAL] Let me see what I have. No, I just have the last 4.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you spell the first and last name for me?
[CUSTOMER][NEUTRAL] Sure. First name is [PII] Last name is [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me see that.
[CUSTOMER][NEUTRAL] Yes, and let me see if I have a card on file.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm pulling up her card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] It's on her card.
[AGENT][NEUTRAL] I have it here. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, I see a different number on here. You pulled it up.
[AGENT][NEUTRAL] Yeah, I see 2. What's the number that you see? Is it 21?
[CUSTOMER][NEUTRAL] I'm looking at 02120426.
[AGENT][NEUTRAL] Mhm, that's what I said too. OK.
[CUSTOMER][POSITIVE] ML 8. OK, thank you.
[AGENT][NEUTRAL] Yeah, this is it. All right. And then, um, well, thank you for verifying. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. It's uh [PII] $44,833.03.
[AGENT][NEUTRAL] OK, and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure, it's Boca Raton Regional Hospital.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII]. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 5582.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy was active from [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] OK. [PII], but these services, uh, they're within that, oh, [PII], OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this is [PII]. Thank you. And no other? Is there any other policy that would cover this?
[AGENT][NEUTRAL] And they haven't had anything with.
[AGENT][NEUTRAL] Well, they may have other insurance, but it's not with APL.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, any other APL? OK, so no other APL coverage after this one. Thank you so much. Can you fax me this ELB because I'm trying to access your portal and it's, I guess you all.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Did an enhancement, because I'm not able to get in.
[AGENT][NEUTRAL] So you'll have to um click the create an OSC account, even if you already have one previously.
[CUSTOMER][NEUTRAL] I did that.
[AGENT][NEUTRAL] So you did that today?
[CUSTOMER][NEUTRAL] I did that.
[CUSTOMER][NEUTRAL] Mhm. Yes, I just did that.
[AGENT][NEUTRAL] And you click that you are a provider?
[CUSTOMER][NEUTRAL] Uh-huh, I put in the tax ID. Do I have to wait for a response?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you receive a verification code?
[CUSTOMER][NEUTRAL] I did that, yeah, I received one then it says it doesn't recognize my email, and I'm like, OK, I'll come.
[AGENT][NEUTRAL] OK. What's your, um, oh, go ahead.
[CUSTOMER][NEUTRAL] Are they still
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I'll go ahead and send this over to IT. So we did just launch the new website on the [PII]. Um, what type of browser are you using?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm using uh.
[CUSTOMER][NEUTRAL] This one is um Microsoft uh.
[AGENT][NEUTRAL] E
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh. Edge and the other one. What's the other one.
[AGENT][NEUTRAL] Chrome
[CUSTOMER][NEUTRAL] It just went out of my hair. Chrome, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I use both.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII]. It's the same as my phone.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And then do I need to put attention [PII]?
[CUSTOMER][NEUTRAL] Uh, you can, but you don't have to. It's my direct fax.
[AGENT][NEUTRAL] OK. Well, I'll go ahead and send the um facts back as the explanation of benefits to you and then um I'm gonna go ahead and put you on this list as well, um.
[AGENT][NEUTRAL] So that we can try to see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let me see if they're doing it for providers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'll go ahead and put you on the list and then um IT or um someone from the IT department should be reaching out to you, we'll reach back out to you um to give to troubleshoot about the online service center.
[CUSTOMER][POSITIVE] Wonderful, and you just
[CUSTOMER][NEUTRAL] Uh, created, did an enhancement on [PII].
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] Oh, wonderful. Thank you so much. And how long, uh, what's the turnaround time for the EOB?
[AGENT][POSITIVE] Oh, I'm getting ready to fax that to you now. So if you don't receive it by end of day today, um, definitely give us a call and we can resend it, but I'm I'm getting ready to do that for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, and I appreciate that. And your call reference number, please.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] All [PII]. That's mine, that's also my initial to my last name.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] All right, that's gonna be all. Thank you so much for your help. Appreciate it.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.