AccountId: 011433970860
ContactId: 6d56e746-813b-49d0-8730-cd46ba593f6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284109 ms
Total Talk Time (AGENT): 126083 ms
Total Talk Time (CUSTOMER): 96080 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/6d56e746-813b-49d0-8730-cd46ba593f6b_20250310T13:55_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, good morning, [PII]. My name is [PII] and I'm with Boca Raton Regional Hospital. I'm calling regarding a medical claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with your medical claim. And just for my notes, can you spell your first name for me and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII] and my number is [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII]. May I have a, um, the member's policy number?
[CUSTOMER][NEUTRAL] Sure, 1578525 ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] And that was 01578525?
[CUSTOMER][NEUTRAL] I don't see a 0. It's just 1578525 ML 8.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII], and that's uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Sure. [PII] $961.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] And can you verify the name of the facility on the claim?
[CUSTOMER][NEUTRAL] Uh, Boca Raton Regional Hospital Incorporated.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 3543485.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. That's the reason why I'm calling cause we billed this claim with the primary EOB attached. So can you check for the attachment, please? United Healthcare EOB.
[AGENT][NEUTRAL] So there was, there was no attachment on the original, but I do see where it was resubmitted on, well, actually, hold on one moment because that's radiology.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's the same thing.
[CUSTOMER][NEUTRAL] You can check the image, please.
[AGENT][NEUTRAL] Um, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's one page.
[AGENT][NEUTRAL] It's your health claim form.
[AGENT][NEUTRAL] There's no other attachment to this. It's just one page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thanks for verifying. And is there a deadline, a timely filing to submit the EOB only?
[AGENT][NEUTRAL] Oh, no, ma'am. You can file at any time as long as the policy was active on the data service.
[AGENT][NEUTRAL] So once you um send that in, we'll go ahead and um continue processing for you.
[CUSTOMER][NEUTRAL] OK, thank you. What
[CUSTOMER][NEUTRAL] Reprocess. Thank you. And the fax number and uh mailing address, please?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And then the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, that's correct. Attention APL claims department.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Thank you. What's the effective date of this policy?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Please, and the term date, please.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII].
[CUSTOMER][POSITIVE] Thank you so much. That's gonna be all the reference number if you have one please, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Oh, mine too.
[CUSTOMER][POSITIVE] All [PII]. Thank you so much. Enjoy your day and your work week.
[AGENT][POSITIVE] Thank you, She let you also and thanks for calling APL.
[CUSTOMER][POSITIVE] You're welcome. Bye-bye.
[AGENT][NEUTRAL] Bye bye.