AccountId: 011433970860
ContactId: aec10ff6-aac8-4755-addf-b1ef93dbeb4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333660 ms
Total Talk Time (AGENT): 164743 ms
Total Talk Time (CUSTOMER): 172437 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/aec10ff6-aac8-4755-addf-b1ef93dbeb4e_20250415T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on Breer Resources. How are you?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you doing?
[CUSTOMER][NEUTRAL] Good good. I don't talked to you in a long time. I have, I know, I have um [PII] with Fortune Insurance. He's a broker and he just uploaded a claim for this customer. Um, I have a policy number. Can you let him know if it came through?
[AGENT][NEUTRAL] I know it's been a while.
[AGENT][NEUTRAL] Yes ma'am, what's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 256-521-8.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK for [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], yes, it took me forever to find him, and he had the policy number because I was like I can't pull him up the other way. But yeah, and I didn't, I didn't verify his date of birth or anything, so I apologize because I couldn't find him until he gave me the policy number, um, so that's my bad and then the call back number for [PII], OK, for [PII] is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's all right.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you so much. You can go ahead and put him through. Thank you, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm gonna pull him on just one second. Thank you. Hey [PII], I have, I have [PII] I have [PII] on the line in our customer care department. She's gonna help you, OK? OK, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Have a great day bye bye. You too take care bye.
[AGENT][NEUTRAL] Hi [PII], this is [PII] in the care team. So, uh, [PII] let me know that you need to verify that a claim came through for um Mr. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], yeah, I have, I have the, uh, claim. I have the, uh, claim number because I, I, I printed it. Give me one second. It is, um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh yes sir.
[CUSTOMER][NEUTRAL] Give me one second. Come on. OK, yeah, it's confirmation number 0SC 96716.
[AGENT][NEUTRAL] Yes, sir. I'm looking at it right now. I do see that it has come through.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, great, yeah, alright, the bill is for $880. How much is, how much is it gonna cover? I'm just curious so I could let him know how much it's actually gonna cover.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, let me look back on this policy real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this is a Medlink, it's a Medlink policy. It's all going to be based on the explanation of benefits from the primary insurance car carrier and the part that they paid.
[CUSTOMER][NEUTRAL] I getting
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So when the claims examiner looks at it, that's how they're gonna be able to determine on what's going to be paid. Now he does.
[AGENT][NEUTRAL] Is it for outpatient or inpatient, sir?
[CUSTOMER][NEUTRAL] I think he was taking that's in the that's the ambulance. I think it was an emergency room.
[AGENT][NEUTRAL] In the emergency room. OK. So, um, he does have an outpatient per calendar day benefit of $500 that goes towards deductible, co-pay, or co-insurance. So right now until the claims examiner looks at it and examines the claim, I, I can't give an amount because it like I said, it all depends on what that EOB comes through from the primary.
[CUSTOMER][NEUTRAL] I believe so, yeah.
[CUSTOMER][NEUTRAL] OK, and that will that go directly to you or do I have to send it to you too because I have something. I have another file I can attach another file too, um, it doesn't have a price right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you send it when you did you send the EOB with this uh claim that came through because all I can see is confirmation number that you gave me. I can't see the documents themselves.
[CUSTOMER][NEUTRAL] You can't see what?
[AGENT][NEUTRAL] I cannot see. I'm not in the claims department so I can't actually see the documents that were sent.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I can um see the confirmation number and see that we have received it when you sent in and received this confirmation number, did you have the explanation of benefits from the primary insurance carrier with this batch that you just sent?
[CUSTOMER][NEUTRAL] OK, so you received it OK.
[CUSTOMER][NEUTRAL] Actually, uh,
[CUSTOMER][NEUTRAL] Yeah, I might have that too. Give me one second. I can, I can, uh, do, I can add another can I add another doc can I add another document to this thing?
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Absolutely. Yes. Because if you don't have that, then it'll come back that we need it. And then you'll have to go through it again. So if you wanna go ahead and add it now, you can.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] How, how could I add a claim I'll just do another claim again and just add the form.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Just do it, just do it again and this that the other form, OK, got it.
[AGENT][POSITIVE] Yes sir, that's exactly how.
[CUSTOMER][NEUTRAL] Alright that uh.
[CUSTOMER][NEUTRAL] OK, let me get another next.
[CUSTOMER][NEUTRAL] Let me select the file and I'm gonna send another one then. OK, it'll be the same claim, but uh.
[CUSTOMER][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] Scan OK there and submit.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's, that's the explanation of benefits I guess from Florida Aventura Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Close.
[CUSTOMER][NEUTRAL] Alright, alright, they're both in there. Alright, so I guess I'll just wait to hear. OK, thank you so much. Uh, how, how long do you think it'll be a turnaro, how, how long do you think the turnaround is gonna be just to have just a guesstimate? I don't need to. How long do you think before they get a response?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, and you're very welcome.
[AGENT][NEUTRAL] Uh, 7 to 10 business days.
[CUSTOMER][POSITIVE] OK, you got it. I'll let him know I submitted in 7 to 10 days we'll get an answer. OK, good enough. Alright, thank you, thank you so much. Have a wonderful day. Alright, God bless bye bye.
[AGENT][NEUTRAL] OK. You're welcome, [PII].
[AGENT][POSITIVE] You too and God bless you too and thanks for calling APL bye bye sir.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Alright bye.