AccountId: 011433970860
ContactId: 4161e7ef-68e5-4ab5-b5c3-bec7db309d57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423380 ms
Total Talk Time (AGENT): 140032 ms
Total Talk Time (CUSTOMER): 139159 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/4161e7ef-68e5-4ab5-b5c3-bec7db309d57_20250221T17:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. My name is [PII] and I'm with uh Boca Raton Regional Hospital. I'm calling regarding a claim.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, that is um.
[CUSTOMER][NEUTRAL] Pull that up for you.
[CUSTOMER][NEUTRAL] 01729439 ML 8.
[AGENT][POSITIVE] Alright, thank you so much. Let me pull this up, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I can get the patient name and date of birth?
[CUSTOMER][NEUTRAL] Certainly, it's [PII]. Uh last name is spelled [PII] uh [PII].
[AGENT][POSITIVE] Thank you so much and then what is the data service?
[CUSTOMER][NEUTRAL] Sure, this is for.
[CUSTOMER][NEUTRAL] [PII] single date for $1,612. A claim denied for primary EOB, however, we attached the primary EOB.
[CUSTOMER][NEUTRAL] To this client. Can you kindly locate it, please?
[AGENT][NEUTRAL] Yeah, let's take a look. You said [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so I do see the claim and I see the denial. It looks like the member's active policy is a different number also. Do you wanna take down the active policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The member's active policy is 0253.
[AGENT][NEUTRAL] 8201.
[CUSTOMER][NEUTRAL] Any alpha in there?
[AGENT][NEUTRAL] Mm mm, no, no letters necessary.
[CUSTOMER][NEUTRAL] Oh, so no letters in there? OK. And what's the effective date for this one?
[AGENT][NEUTRAL] Uh, so it looks like effective date for this one is [PII].
[CUSTOMER][NEUTRAL] To present?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. And what about the one that I provided? What's the?
[CUSTOMER][NEUTRAL] B for that one.
[AGENT][NEUTRAL] That policy was effective [PII] until [PII].
[CUSTOMER][NEUTRAL] Oh, OK, OK, so we build under the, uh, what's the data service here 9 we build under the term one, OK, uh, can you locate the please locate the primary EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm looking to see what was submitted on the claim here. Give me just one second.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] All right [PII], thank you for waiting. So I don't see a primary EOB. All I see is one page and it looks like it's a bill from Boca Raton Regional Hospital.
[CUSTOMER][NEUTRAL] OK, so only one page received. Thank you. Um, what's the fax number?
[AGENT][NEUTRAL] Our fax number is going to be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that a tension claims?
[AGENT][NEUTRAL] Yep, just attention claims yes ma'am.
[CUSTOMER][POSITIVE] Thank you, [PII]. And the mailing address, please, and timely filing to send that.
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Absolutely no timely filing and our claims mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. Do you think after sending the primary EOB there's a chance that it may deny for a new coverage, or will the plan automatically process under the um the active?
[CUSTOMER][NEUTRAL] Policy.
[AGENT][NEUTRAL] Yeah, it should just process under the active policy. The claim was received under the active policy. Um, it was actually filed under the one ending in 201, even though the old one was on there.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][POSITIVE] OK, because on our claim I see the old one. OK, but the plan did process under the, the active 10, great, great move. Thank you so much and the call reference number, please.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Absolutely. Yeah, call references my name with my last initial than today's date. My name is [PII], which is [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Thank you. I was just gonna ask you for the spelling to your name because
[CUSTOMER][NEUTRAL] Sometimes I spell it [PII] I'm like, OK.
[CUSTOMER][NEUTRAL] That one is tricky. Uh, it's the same thing like [PII]. I have problem with [PII], [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] I always need help.
[CUSTOMER][POSITIVE] Thank you so much. Appreciate it and enjoy your day and your weekend.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] All right you too, [PII], take care.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.