AccountId: 011433970860
ContactId: eb808a7a-109f-4a39-bf9f-ea3bf653d9f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 988590 ms
Total Talk Time (AGENT): 264679 ms
Total Talk Time (CUSTOMER): 258419 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/eb808a7a-109f-4a39-bf9f-ea3bf653d9f0_20250423T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I, I wanted to follow up on a claim, uh, and see if you guys received uh the claim and paid something for it.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] Thank you ma'am. And then uh what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So it's myself. So [PII], and it's [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02036914 M as in Mary, L as in Louis 7.
[AGENT][NEUTRAL] OK, Ms. [PII] and uh when did you send the claim in?
[CUSTOMER][NEUTRAL] So this was uh for date of service [PII].
[AGENT][NEUTRAL] OK, and do you know what the charge amount was?
[CUSTOMER][NEGATIVE] Sorry, you're cutting off. What is?
[AGENT][NEUTRAL] I'm sorry, do, do you know what the charge amount was for the claim?
[AGENT][NEUTRAL] How much it was?
[CUSTOMER][NEUTRAL] Yeah, so the original charge was 1, 181,19513 cents.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold, Miss [PII], while I look up this claim for you and I will be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, ma'am
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Miss [PII], this is Tory back with you again. So I do show the claim the claim number is 354-855-3, and the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. I already had spoken with Aetna for this month ago.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and um so it let me tell you.
[CUSTOMER][NEUTRAL] And you still haven't received it?
[AGENT][NEUTRAL] Right, let me tell you what the remarks state. We have received the primary explanation of benefits of your claim, however, the explanation of benefits received does not list the deductible copay or co-insurance.
[AGENT][NEUTRAL] Amounts applied, please submit a more detailed explanation of benefit that shows these.
[AGENT][NEUTRAL] Amounts for further consideration of your claims, so the explanation of benefits that we need that needs to show the deductible co-pay or co-insurance that was.
[CUSTOMER][NEGATIVE] So you're cutting off.
[CUSTOMER][NEGATIVE] Sorry, I, you're cutting off I'm missing half of what you're saying.
[AGENT][NEGATIVE] It needs to show the deductible.
[AGENT][NEUTRAL] I'm sorry, let me see if I can work this out.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so what it's stating is the explanation of benefits.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Needs to have the deductible co-pay or co-insurance amount appli that was applied on the explanation of benefits that they sent in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you received the explanation of benefits but it's missing, so it needs to include the deductible copay amount.
[AGENT][NEUTRAL] Right, that have been applied.
[AGENT][NEUTRAL] To the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And where, so Aetna is my primary, so where should they be sending this?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me, um, well, there's there's several different ways they can send it. They can um send it electronically would probably be the easiest for them. Let me give you the payer ID number.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK, it's 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They can also fax it. Let me give you the fax.
[CUSTOMER][NEUTRAL] So this is the payer ID.
[AGENT][NEUTRAL] Yes, that's the payer ID number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And sorry if they how do they send it to, so how do they do it with the payer ID?
[AGENT][NEUTRAL] Let me give you the fax number.
[AGENT][NEUTRAL] Electronically through the computer.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Sorry, because you're cutting off. I'm sorry about that so it's not fax.
[AGENT][POSITIVE] Mhm. I'm so sorry.
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll just repeat that. So it's [PII].
[CUSTOMER][NEUTRAL] Or 23.
[AGENT][NEUTRAL] 942-223.
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. And so once,
[CUSTOMER][NEUTRAL] You received that um I mean so once you received the explanation of benefits, did you send back to Aetna saying this is not enough?
[AGENT][POSITIVE] Yes, they receive an explanation of benefits.
[AGENT][NEUTRAL] From us.
[CUSTOMER][NEUTRAL] And when was that?
[CUSTOMER][NEUTRAL] Sent.
[AGENT][NEUTRAL] Uh, let me look, um.
[AGENT][NEUTRAL] Let me see what date that the it was processed.
[AGENT][NEUTRAL] We process the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so it's I've been dealing with this for months already. It's like insane.
[CUSTOMER][NEUTRAL] OK, so I guess I have to call Aetna again for them to send you.
[CUSTOMER][POSITIVE] A detailed explanation.
[CUSTOMER][NEUTRAL] OK. Now, once you guys receive it, how long does it take?
[AGENT][POSITIVE] Yes, and make, make sure that they have.
[AGENT][NEUTRAL] It takes 7 to 10 business days to process the claim once we receive all the information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you were gonna say, uh, make sure they have.
[AGENT][NEUTRAL] That deductible, co-pay or co-insurance that was applied. That's the main thing that they're looking at.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK then, so I'll give you, I'll give them a call again.
[CUSTOMER][POSITIVE] But I appreciate your help.
[AGENT][NEUTRAL] OK, Miss [PII].
[AGENT][POSITIVE] Yes, yes, is there anything else I can help you with before we go, ma'am?
[CUSTOMER][NEUTRAL] Oh yeah, it's just, uh, can I give you another claim and see if you guys um received that as well?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Let's see, so it's for the same day of service, so [PII].
[AGENT][NEUTRAL] What is the data service for that one?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and this is for Boca Radiology Group.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] OK, and do you know the charge amount?
[CUSTOMER][NEUTRAL] Yes, the original charge was for 3,295.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I look this one up and I'll be right back with you, Miss [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 3582625
[AGENT][NEUTRAL] Thank you, Ms. [PII], for holding for me. So, um, you said it was for Boca radiology. Would that be um also MBB radiology?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Um, it says BRG.
[AGENT][NEUTRAL] P R G
[CUSTOMER][NEUTRAL] Oh sorry, account MBBAC maybe.
[AGENT][NEUTRAL] Yes, OK, so that claim was paid $500.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I can give you the check number. It was sent to MBB radiology.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The check number is 203-6108.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You said that was for 500.
[AGENT][NEUTRAL] Yes ma'am, and it was paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, so it seems the one for Boca Regional is that you haven't been able to get the correct information, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so let me get Aetna back on the phone and see if I can straighten this one second.
[AGENT][NEUTRAL] Yes, ma'am. OK, I understand.
[CUSTOMER][NEUTRAL] That's you.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][POSITIVE] All right. Well, I'm glad I was able to help you. I hope you have a wonderful day. Thank you for calling APL Ms. [PII]. Bye-bye.
[CUSTOMER][POSITIVE] You too. Thanks.
[CUSTOMER][POSITIVE] Thank you bye bye.