AccountId: 011433970860
ContactId: 4fff32f6-9207-42b4-905c-f268537adba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342380 ms
Total Talk Time (AGENT): 111083 ms
Total Talk Time (CUSTOMER): 162926 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/4fff32f6-9207-42b4-905c-f268537adba4_20250307T20:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I called yesterday to find out about a claim that was submitted for my husband [PII]. Wait, [PII], and um, you're gonna need his verbal authorization to talk to me. So can I, can we give, give that to you now?
[AGENT][NEUTRAL] Well, can you give me the policy number first so I can pull up the information?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] 01893557
[AGENT][NEUTRAL] OK, thank you, ma'am. And your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], thank you, ma'am.
[AGENT][NEUTRAL] And give me a moment. OK. Yes, ma'am. If I can speak to Mr. [PII], please.
[CUSTOMER][POSITIVE] I am right here.
[AGENT][NEUTRAL] OK, and Mr. [PII], verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] And Ms. [PII], you said that you're calling for claim status from Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, I have a question about additional information that's being requested.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, uh, this is for a claim on date of service I believe is the [PII], yeah, [PII] of this year.
[CUSTOMER][NEUTRAL] The person I spoke with yesterday said I need a UBO4 from the hospital.
[CUSTOMER][NEUTRAL] And that the um explanation of benefits that you received was um not to the hospital.
[AGENT][NEUTRAL] OK, and let me look at the claim. Give me one quick moment.
[AGENT][NEUTRAL] 62.
[AGENT][NEUTRAL] OK one moment. I'm just gonna pull up the claim.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And this was for the hospital, what Boca, Boca Raton Regal?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Yes, ma'am. Um, I don't show the EOBs for the, uh, for the facility.
[CUSTOMER][NEUTRAL] Right, I'm, I'm waiting for uh the hospital to send that to me now. I just hung up the phone with them and they are going to send it and I'll upload it and send it to you. Um, uh, what about the EOB from United? Do you have what you need?
[AGENT][NEUTRAL] Well, the EOB doesn't, or the EOB from United doesn't have the hospital charges, but um it looks like for the other information we're needing diagnosis codes for this confinement.
[CUSTOMER][NEUTRAL] Right, and that's, um, I was told the UBO4 would have correct?
[AGENT][NEUTRAL] Uh, UBO4, yes, ma'am. That's the standard form for the facility.
[CUSTOMER][NEUTRAL] OK, so is that the only missing piece of information in order to process the claim?
[AGENT][NEUTRAL] Uh, let me double look.
[AGENT][NEUTRAL] Uh, yes, ma'am. Looks like we just need that um.
[AGENT][NEUTRAL] The EOB for the facility charges and the diagnosis code. So if you have that UBO4, if you can submit that to us.
[CUSTOMER][NEUTRAL] OK, as soon as um that comes through, I will, um, I thought there was a question about the explanation of benefits from the hospital, and I have gone on to United Healthcare's website and um printed out the, um, [PII] surgery charges.
[CUSTOMER][NEUTRAL] And I'm getting the provider billing, but the hospital billing, yeah, there it is. OK, um, I'm pretty sure I submitted that already because when I printed it out a second time.
[CUSTOMER][NEUTRAL] I got exactly the same thing I got the first time, so I just wanna make sure that another week doesn't go by and um when I call to find out the status, I'm told, oh, you didn't send this, so can you just confirm that the only thing I need to send you is the UBO4 with the diagnosis.
[AGENT][NEUTRAL] And the EOB because I don't know if you have that EOB that you submit to us. If you look where it says provider, it just says BOA anesthesia or comprehensive. It doesn't state the facility.
[CUSTOMER][NEUTRAL] OK, all right, very good then I'll get the and when I fax those items over, I don't need a cover sheet that it will just get um linked or do I? Do I need to send the claim form again?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I know, you don't need to send the claim form again, um, but you can put it in reference to a claim number if you like.
[CUSTOMER][NEUTRAL] OK, can you give me what that claim number is?
[AGENT][NEUTRAL] Yes, ma'am. It's 357-062-1.
[CUSTOMER][POSITIVE] OK, very good, thank you so much.
[AGENT][POSITIVE] Uh yes, ma'am. Thank you for calling APL. Y'all have a great day and weekend.
[CUSTOMER][POSITIVE] Thank you you too.