AccountId: 011433970860
ContactId: 6b48bca2-8261-4522-a8d5-ac1d7ad86e86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326720 ms
Total Talk Time (AGENT): 89354 ms
Total Talk Time (CUSTOMER): 131784 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/6b48bca2-8261-4522-a8d5-ac1d7ad86e86_20250516T15:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the business office of Orlando Health, and this call is being recorded and monitored, and I'm just calling to get uh more information on one claim.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And you have the policy number of that patient?
[CUSTOMER][NEUTRAL] Yes, it's 137. I'm sorry, no, it's 0171735216, M as in Mary, L as in Lima, and 7.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] of [PII].
[AGENT][NEUTRAL] Uh, do you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, it's for 12024 with the billed amount of $7,792.97 just to let you know, just quickly, we first processed this back in January it denied for, um, requesting primary EOB we submitted it and then it seemed like it got denied again on and just recently in April.
[CUSTOMER][NEUTRAL] For the same reason.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um, what was the patient's name and date of birth again?
[CUSTOMER][NEUTRAL] [PII] or [PII], [PII].
[AGENT][NEUTRAL] OK, this looks like an old policy number. Let me pull up the current one.
[AGENT][NEUTRAL] And you said it was from [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Other policy pulled up.
[CUSTOMER][NEUTRAL] OK, so is this, this policy is still active?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, um, but when they renewed, sometimes the policy numbers change, so the policy number you gave me was that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 19 to 2019 to 2023, then the one you're referring to is active from 23 to 24, and then there's a current policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get that
[AGENT][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] OK, so you said you were submitted it in January, it was denied for primary EOB and then submitted it again in March, is that right?
[CUSTOMER][NEUTRAL] Yes, we submitted it to fax number [PII].
[CUSTOMER][NEUTRAL] Um, with the primary EOB.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEGATIVE] And it seemed like it denied again for the same reason.
[AGENT][NEUTRAL] OK, let me pull up what we received.
[AGENT][NEUTRAL] Uh, give me just one moment, I'm pulling it up.
[CUSTOMER][POSITIVE] Oh, sure. Thank you.
[AGENT][NEUTRAL] OK, it looks like the 2nd submission just had the UBO4.
[AGENT][NEUTRAL] Um, I don't show, uh, the, uh, primary AOBs attached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, and we can go ahead and um is that fax number I provided you the correct fax number?
[AGENT][NEUTRAL] Uh, yes, [PII].
[CUSTOMER][NEUTRAL] OK, and the time you're filing to submit that?
[AGENT][NEUTRAL] Uh, there's no timely filing and then if you'll just reference that claim number 3581491.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, give me one second. OK, maybe that's what I'm missing. You said um the claim number is 3581491. Excuse me.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, 3581491 is the claim number and um we have the correct facts, no timely limit. OK, um, sounds good. Thank you so much. Is there a reference number for today's call?
[AGENT][NEUTRAL] Uh, reference number is just my name, [PII]. Sure, go ahead.
[CUSTOMER][NEUTRAL] Oh, and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I was going to ask, um, do we need to submit the, the, the claim again with this or just the EOB with maybe the claim number on there?
[AGENT][NEUTRAL] Uh, just the claim number is fine on that explanation of benefits.
[CUSTOMER][POSITIVE] OK perfect thank you so much and just your name and today's date, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much. You enjoy your weekend.
[AGENT][POSITIVE] Thank you. You too. Thanks for calling APL.