AccountId: 011433970860
ContactId: 3fd31def-8453-41f7-9070-acbcdbabd7be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509959 ms
Total Talk Time (AGENT): 217308 ms
Total Talk Time (CUSTOMER): 185165 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/3fd31def-8453-41f7-9070-acbcdbabd7be_20250519T13:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. Um, I wanted to follow up on a claim and see if you guys received an explanation of benefits from my primary regarding it.
[AGENT][NEUTRAL] OK, let's take a look. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's um let me see here. So it's 02036914 M as in Mary, L 8.
[AGENT][NEUTRAL] All right, let me pull that up here one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] And if I could get first name, last name, and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you. And then the last thing I'll need to verify is just the physical address.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then [PII], do you have, do you know what the claim number was or the date of service?
[CUSTOMER][NEUTRAL] The date of service was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so it looks like we did get an explanation of benefits because there was something sent off to the provider.
[AGENT][NEUTRAL] Um, so yeah, it looks like we did get other explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, earlier this year it was around February. I see we received one.
[CUSTOMER][NEGATIVE] Cause I called, so you guys have received one which wasn't enough, and you asked me to, well, not you, someone in the office asked me to call Aetna, which is my primary insurance, and have you resend an explanation.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't know if you have anything new or what you have is sufficient to
[CUSTOMER][NEUTRAL] To processing?
[AGENT][NEUTRAL] So, yeah, I mean, what I see is that it looks like there was
[AGENT][NEUTRAL] Was it for a radiology center? Was that what it was for?
[CUSTOMER][NEUTRAL] For, for Boca Raton Regional Hospital.
[AGENT][NEUTRAL] OK, I mean.
[CUSTOMER][NEUTRAL] So there's 2 bills for that date of service.
[AGENT][NEUTRAL] OK. OK. That makes sense.
[CUSTOMER][NEUTRAL] There's one for a radiology group, a Boca Radiology group, and the other one for Boca Regional.
[AGENT][POSITIVE] OK, I see what I see now. OK. I'm sorry about that.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yeah, it does say we received the primary explanation of benefits that was submitted. However, it does not list the amount applied towards deductible, co-pay or co-insurance, so we need a more detailed one.
[AGENT][NEUTRAL] Um so.
[AGENT][NEGATIVE] That was the one that the last that was received, but it wasn't.
[AGENT][NEUTRAL] Looks like they're showing.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, yeah, I don't see anything else, [PII], that's been received since the original one was sent and then it said it wasn't enough information.
[AGENT][NEUTRAL] Uh, because it doesn't show what was applied towards the deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] So, um, the one that we got, it, it's all blank and not in those areas.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so it's, I called, I think, already 3 times through several months asking for this, uh, to Aetna. I
[CUSTOMER][NEUTRAL] Is there any way that you guys can talk to them and maybe they it goes through because for me again, that's why I'm following up every couple of weeks and like what's going on.
[AGENT][NEUTRAL] Do you have, like, most major carrier insurances have like an online portal. Do you have anything like that that you can access? Could you
[CUSTOMER][NEUTRAL] I do, but the, yeah, but the explanation of benefits, it's empty.
[CUSTOMER][NEGATIVE] There's nothing uploaded there.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I don't have access to it either.
[CUSTOMER][NEUTRAL] So they when I called you guys last time you they had given me the payer ID number and the fax number for for them to send it to you.
[AGENT][NEUTRAL] Um, yeah, I mean, generally,
[AGENT][NEUTRAL] Um, I mean, they should be able just to send it to you. That's strange that you, you should have access to all that online. Um, I mean, it's pretty much.
[AGENT][NEUTRAL] All right, as far as like an insured to like have your explanation of benefits, so.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see, so one thing, so when I was told that.
[AGENT][NEUTRAL] I mean if I were, yeah I mean if I were you, [PII], I would just be calling them and saying I need this now please email it to me and I would stay on the line with them until you receive it because you should have full access to all that information online, especially from something that was done back in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, OK. So what, what is missing is the explanation, uh, needs to include deductible, co-pay.
[CUSTOMER][NEUTRAL] The amount, let me see.
[AGENT][NEUTRAL] Correct. Right. The amount for the right, towards the deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Uh, that have been applied.
[CUSTOMER][NEUTRAL] And that's not in the explanation of benefits that they sent?
[AGENT][NEGATIVE] What, well, the explanation that came over, all those amounts are empty. There's nothing on there.
[AGENT][NEGATIVE] It doesn't even have patient name, patient date of birth, anything.
[CUSTOMER][NEUTRAL] That's so strange. OK.
[AGENT][NEUTRAL] It's just blank, yeah.
[CUSTOMER][NEUTRAL] OK, I gues[PII] I'll call and then give you guys a call again.
[AGENT][NEUTRAL] Um, I mean, if they give it, yeah, they send it to you, then you could fax it to us or, you know, upload it yourself that way you don't have to wait for them to do it.
[CUSTOMER][NEUTRAL] OK, um, and then.
[CUSTOMER][NEUTRAL] OK, and the fax is [PII]?
[AGENT][POSITIVE] Mhm, yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, and payer ID number that was given was 60801?
[AGENT][POSITIVE] Mhm, that is correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And then for the other uh bill that you were seeing that it's for the radiology group that was processed by you guys?
[AGENT][NEUTRAL] Mm mhm. That was processed. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, very good. OK then, so let me get back to it one second.
[AGENT][POSITIVE] All right, [PII], thanks for calling.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][NEUTRAL] Uh-huh, bye bye.