AccountId: 011433970860
ContactId: b48aff85-e793-4eab-8521-eb4a879964ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370380 ms
Total Talk Time (AGENT): 169753 ms
Total Talk Time (CUSTOMER): 108633 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/b48aff85-e793-4eab-8521-eb4a879964ef_20250610T19:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. This is [PII] with uh Boca Raton Regional Hospital. I'm calling for claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is, um, could you spell your name for me so I get it correctly?
[CUSTOMER][NEUTRAL] Sure. [PII]
[AGENT][POSITIVE] Thank you and what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Sure. It's 02270277 ML8.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits if not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, this patient is [PII], [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] $11,671.74.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that this claim was received, um, it was received on [PII] and it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3604115.
[AGENT][NEUTRAL] And the reason for the denial on this claim, um, [PII], is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, thank you. Is that claim number 3604115?
[AGENT][NEUTRAL] Yes, ma'am, it is. Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. We did um attach the primary EOB. Can you try to locate it, please? It's a Blue Cross EOB.
[AGENT][NEUTRAL] I can see if it's attached. Yes, ma'am. I can look to see if it was received, but according to the records, that was not received with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] But I'll be happy to double check.
[CUSTOMER][NEUTRAL] Yeah, sometimes it gets overloaded. OK. Thank you.
[AGENT][NEUTRAL] Oh certainly.
[AGENT][NEUTRAL] So no, ma'am [PII] we only received one page.
[AGENT][NEUTRAL] And that is the claim. Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] One page? Oh, OK.
[CUSTOMER][NEUTRAL] Thank you for checking. And a fax number?
[AGENT][POSITIVE] Oh, you're well.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] 3659423 attention claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that [PII]?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] Thank you. And a mailing address, please, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, timely filing, please.
[AGENT][NEGATIVE] No timely filing?
[AGENT][NEUTRAL] And if you need a copy of this. Oh, you're welcome, [PII], and if you need a copy of this um explanation of benefits without remark, you can print it by going to our portal now that you have the claim number and our website for the portal is located at [PII].
[CUSTOMER][POSITIVE] No problem. Thank you so much.
[CUSTOMER][MIXED] Mm thank you. I use your portal a lot, so, uh, you know, I didn't have the claim number. We received a 0 payment, but I said, I don't have the claim number. I don't have the last four of the social. I wish your portal would allow to search without that last 4.
[AGENT][POSITIVE] Oh great. Uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. And I, um, but I'm, yeah. Uh, well, hopefully, at some point, we will be able to do that. But at this time, if you're unable to locate it, just call us and we'll be happy to check the status for you. And then with the claim number, you should be able to access what you're needing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes. Yes. Thank you so much. Appreciate your help, [PII].
[AGENT][POSITIVE] OK. Oh, absolutely. You're very welcome. And is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] That's gonna be all for now. You may hear from me again for today.
[AGENT][NEUTRAL] Uh well, I'll be here uh for a little while longer. So, yes, ma'am, you just give us a call back.
[CUSTOMER][POSITIVE] OK, will do. Thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you again for calling APL. Have a great evening.
[CUSTOMER][POSITIVE] Thank you too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.