AccountId: 011433970860
ContactId: 839b49f7-03dd-4c96-a403-10f804dae8cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440549 ms
Total Talk Time (AGENT): 201443 ms
Total Talk Time (CUSTOMER): 131087 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/839b49f7-03dd-4c96-a403-10f804dae8cb_20250127T20:54_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII], it's [PII] Amazon Moon. How are you?
[AGENT][POSITIVE] Hey, I'm doing wonderful, Miss [PII], thanks for asking. How about yourself today?
[CUSTOMER][POSITIVE] I'm doing good as well.
[AGENT][NEUTRAL] How can I help you, my friend?
[CUSTOMER][NEUTRAL] I am calling to check on the status of a patient's claim as secondary.
[AGENT][NEUTRAL] Yes, we are, uh, well, I would assume we're secondary, um, and you said you want to check on a claim that was processed as secondary?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Wonderful, I'd love to help you with that. Do you mind if I snag a good callback number for you?
[CUSTOMER][NEUTRAL] Sure, direct line [PII].
[AGENT][POSITIVE] Wonderful and what's the policy number we wanna pull up today for your member?
[CUSTOMER][NEUTRAL] Uh, the ID number, it's going to be 02249722.
[AGENT][POSITIVE] Wonderful. Let me get that pulled up for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. I appreciate your patience and would you verify your member's first and last name and date of birth for me?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][POSITIVE] Wonderful. I do see [PII] right here and do you have a claim number or date of service you'd like us to look at?
[CUSTOMER][NEUTRAL] Uh, date of service, it's going to be, um, date range [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] In [PII] wonderful and what was that billed them out?
[CUSTOMER][NEUTRAL] Um, now, here is the question. I'm not sure if it's billed under one full claim or if it's built separately because I have one separate. The first claim is billed amount of $26,591.19.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, can you repeat that? 26,000.
[CUSTOMER][NEUTRAL] $591.19.
[AGENT][POSITIVE] Wonderful and then you said you also had it broken out into two separate?
[CUSTOMER][NEUTRAL] Yes, the second one is for a date range. It says [PII], $23 single date billed amount, $4430 even.
[AGENT][NEUTRAL] All right, perfect. And those bill amounts for those um your billed amounts pre-major medical or post-major medical?
[CUSTOMER][NEUTRAL] I believe these are pre.
[AGENT][NEUTRAL] Do you happen to have that post-major medical bill amount on hand?
[CUSTOMER][NEUTRAL] Um, let's see, um, the first one, it's, um,
[CUSTOMER][NEUTRAL] Let me see I can pull it up.
[CUSTOMER][NEUTRAL] Uh, let's see, it's.
[CUSTOMER][NEUTRAL] I'm logging back into the system to pull it up. Give me one second.
[AGENT][NEUTRAL] You're fine, no worries here.
[CUSTOMER][NEUTRAL] OK. Post-medical bill on the first one, the pending balance is $1,503.53.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After primary Aetna.
[AGENT][NEUTRAL] And what is the name of the facility on file?
[CUSTOMER][NEUTRAL] It's listed under Boca Raton Regional Hospital.
[AGENT][NEUTRAL] OK, so I believe I found the claim for your first one. I show claim number um 3541803.
[AGENT][NEUTRAL] And hang tight one second, let me go back.
[AGENT][NEUTRAL] A step it looks like we received that claim 12-13-2024 and we processed it on 12-17-2024. I am showing that this claim was denied just requesting a copy of the um major medicals EOV.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then for that second claim,
[AGENT][NEUTRAL] I have.
[AGENT][NEUTRAL] Two different claim numbers to pull up and look at and let me just narrow that one down a little more for you my friend.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also for Boca.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Would that second one be also for the medical center or would it be for a particular service within the medical center?
[CUSTOMER][NEGATIVE] No, it should not.
[AGENT][NEUTRAL] OK, so I don't, it looks like I don't have your 2nd 1 on file at all for just the 30th by itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, in that case, um, so we'll need to submit that claim, uh, what is the um.
[CUSTOMER][NEUTRAL] [PII] found as a secondary for that part of the claim.
[AGENT][NEUTRAL] And I'm so sorry, would you repeat your question, Ms. [PII]?
[CUSTOMER][NEUTRAL] What is going to be the timely filing as secondary for that second part of the claim?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] We do not have a um a timely filing limit so you're welcome to submit that at any time uh for that first claim you just have to send the EOB. You don't need to refill out a claim form, um, just like send us a copy of that EOB and then that second claim, go ahead and submit it any time you choose and as long as benefits are payable, um, we will take care of it.
[CUSTOMER][NEUTRAL] OK, submit it to what address?
[AGENT][NEUTRAL] Oh yeah, you betcha. Um, so we have our mailing address is [PII], that is in [PII].
[AGENT][NEUTRAL] Our zip code is [PII]. We also have a fax number or an electronic payer ID if that suits you.
[CUSTOMER][NEUTRAL] OK, what's that, uh, fax number and pay ID?
[AGENT][NEUTRAL] You bet your fax number is [PII] and the payer ID is 60801.
[CUSTOMER][NEUTRAL] And for the primary, it will be that's pending, is that also supposed to be submitted to the same address?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then when you submit that second claim, um, just make sure you include that EOB in it so that way it doesn't get denied pending EOB for you.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll go ahead and do that and [PII], how do you spell your name and the reference number, please?
[AGENT][POSITIVE] What a wonderful question. So my name is [PII], last initial [PII], and the reference number is just my name and today's date.
[CUSTOMER][POSITIVE] Awesome [PII], I appreciate your time and help. I'll go ahead and get that sent in.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thank you for calling APL and you have such a fabulous day.
[CUSTOMER][POSITIVE] You as well take care thanks.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.