AccountId: 011433970860
ContactId: a95bb2d9-53bf-4ee6-b553-abdb2c833502
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505750 ms
Total Talk Time (AGENT): 270661 ms
Total Talk Time (CUSTOMER): 201573 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/a95bb2d9-53bf-4ee6-b553-abdb2c833502_20250509T16:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII] in customer service. I have Ms. [PII] on the line with policy number 258.
[CUSTOMER][NEUTRAL] 5126.
[AGENT][NEUTRAL] Alrighty, you want to go and give it to me?
[CUSTOMER][NEUTRAL] Mhm, yes, um, she has an issue with uh one of her claims that she recently submitted for April and she has a couple of questions about it. I already helped her um with her creating her account with the online service center.
[AGENT][POSITIVE] OK, go ahead and give it to me then. Thanks so much. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, is this, is this [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi [PII], this is [PII] over in the claims department. How can I help you today?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I was just calling because I, uh, I wanted to check in on the claims. I think I know what I need to do. Um, I sent, I wanted, I wanted to first see if um Boca Regional had submitted the claim themselves because for my um emergency room visit on the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] because I call when I called them on Monday after Cigna, you know, processed my primary processed the claim, I got like this bill but then I didn't know if they had, um, you know, ran it through you guys yet because I couldn't log into the portal which that's now been corrected thankfully um I can get in, but um they said when I called on Monday they said that they hadn't submitted it but then I sent my EOB from um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Boca Regional on like 2 days ago and I got an email saying that they submitted the claim but then they need like more information. I need to call them for like an ELB or something like that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, let's see, I do see the claim that you just submitted. We, we got in yesterday, uh, but I don't see.
[AGENT][NEUTRAL] That the hospitals has submitted a bill in their self for data service for 17 yet.
[AGENT][NEUTRAL] I see a claim for an urgent care, but that's
[AGENT][NEUTRAL] On [PII], but you said it was from Boca Regional Hospital?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm, I don't see that they've sent that claim in yet, no, ma'am, but I do see the claim that you submitted yesterday that we received uh in house yesterday.
[AGENT][NEUTRAL] But I don't say the hospital, mm, yeah.
[CUSTOMER][NEUTRAL] OK, so that's for the
[CUSTOMER][NEUTRAL] OK, so you, I submitted two claims. It was, um, the one for the MD now bill that one had an actual claim number when I submitted it. I have the claim number, um, because, and they said that they were gonna resubmit it or something like that.
[AGENT][NEUTRAL] Oh well, OK, yeah, they have not done that yet, but it looks like that they are still, you know, processing the OSC claims in in-house because we just received one yesterday and it may be late today or even Monday before they actually get that keyed in. So maybe just check back on Monday and see if they've all come through, but as of right now I don't see Boca Regional has submitted anything for 4:17.
[AGENT][NEUTRAL] Not from the hospital port, yeah.
[CUSTOMER][NEUTRAL] OK. So which claim, which claim are you seeing? Which claim are you seeing?
[AGENT][NEUTRAL] From the one that you submitted yesterday on the OSC?
[CUSTOMER][NEUTRAL] I sent you, yeah, I sent you one for Boca Regional, but then also one for MD now which, which you said or whoever I was speaking to said they were gonna resubmit it, um, that one had a claim number.
[AGENT][NEUTRAL] Oh, OK. Let me just see.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Claim number 359.
[CUSTOMER][NEUTRAL] 4911
[AGENT][NEUTRAL] Yeah, that's for the right that is for the urgent care on 4:15, yeah, for 3:41, yeah. OK, let me see what you said in 18 pages, so give me just a moment to look at all of this, [PII], let's see.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Services provided by Boca Regional that's on your first page.
[AGENT][NEUTRAL] Let me go, keep going, hang on, let's see.
[AGENT][NEUTRAL] And you got the EOB total bill 2057, so yes, ma'am, that is the emergency room bill that that you submitted, but yeah.
[AGENT][NEUTRAL] We do have that one in.
[CUSTOMER][NEUTRAL] So, there's a claim for that one, right?
[AGENT][NEUTRAL] Mhm, I do have that one in.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What's the claim number on that?
[AGENT][NEUTRAL] It's not a claim number yet. It just has a mail number which tells me that it's, it's been put in the system yesterday, but it's not gonna have a claim number until we actually process your claim, which give it at least 55 to 10 working days for that to go through the system and get processed, yeah, but we do have it. We did receive it yesterday.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But whoever
[CUSTOMER][NEUTRAL] OK, but whoever said sent me this email yesterday said similarly the claim for Boca Regional EOB has been sent to our claims department, which is what you're seeing, but we require additional information to finalize the cl[PII]. Please contact the hospital to obtain an itemized bill that includes your diagnosis and procedure codes, or alternatively you can request a UB 04 form for the relevant data service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, that's what I'm looking at all your pages you sent in and I'm not seeing because we do have to have that uh documentation in writing from the provider's office or hospital that actually tells us the diagnosis code which I'm looking for on all the stuff you send us, but I'm not seeing one as of right now so that is why they're letting you know what we need already to go ahead and contact that hospital.
[AGENT][NEUTRAL] Because we will, we will ask for that. I do send MD now for 341. Yeah, it's all in one, it's all in one,
[AGENT][NEUTRAL] One claim
[AGENT][NEUTRAL] Your data service 415, you did send it.
[AGENT][POSITIVE] Yeah, I have it all together. I see it.
[CUSTOMER][NEUTRAL] Yeah, I, I mean it, but it, that should be a different, that should be a different claim, like that's, that's a different claim.
[AGENT][NEUTRAL] Yeah, it's a, well, what we do is when you send the OSC in even though you might send 1 or 2 or 3, it gets combined into one here we process it all into one claim.
[CUSTOMER][NEUTRAL] OK, so that one's being reprocessed though.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, yeah, and that's the one that we received into yesterday as well, but yeah, I would go ahead, um, like I said, and contact book Original because we will need a copy of a diagnosis code in writing. The best way to get that though, [PII], is to call the hospital and tell them that that you need for them to send you uh a what we call a UB 92 form. It's gonna have everything on it that we need.
[CUSTOMER][NEUTRAL] UB 92.
[AGENT][NEUTRAL] You, yeah, you'd be 92.
[AGENT][NEUTRAL] If I can give that to you, you can send them. Mhm.
[CUSTOMER][NEUTRAL] Oh, I thought that they, they wrote in the email.
[CUSTOMER][NEUTRAL] They wrote in the email UB04.
[AGENT][NEUTRAL] Yeah, well, it's the same thing. You can call it UBO4 or you can call it a UB 82, UB 92, it's all the same for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Alrighty, well, I'll get that.
[AGENT][NEUTRAL] Yeah, over the years they're just changing it.
[CUSTOMER][POSITIVE] No worries, I understand. I'll get that to you, OK?
[AGENT][NEUTRAL] OK, [PII], will you just send that over to the OSC website and then like I said, we will combine it and go ahead and and get it all processed, but yeah.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] OK. Well, yes, ma'am, [PII], and is that all I can help answer for you today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] OK, yes ma'am, [PII], and thanks for calling APO. You have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, man. Bye-bye.