AccountId: 011433970860
ContactId: 1f3688ac-57ff-4542-ab7b-8ad2fafbdd37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396380 ms
Total Talk Time (AGENT): 97486 ms
Total Talk Time (CUSTOMER): 222410 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/1f3688ac-57ff-4542-ab7b-8ad2fafbdd37_20250609T15:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII], and I am calling because um I wanna know if the center where I am doing my rehab has submitted some documents because we have changed, I have changed insurance in [PII], and I need to continue my rehab. So I wanna see.
[CUSTOMER][NEUTRAL] The status and if I can continue my rehab.
[AGENT][NEUTRAL] May I have your policy number? I'll pull up your file.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] The policy number I just I have to.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] This one.
[CUSTOMER][NEUTRAL] The policy number is 17768.
[CUSTOMER][NEUTRAL] And the certificate or the certified number. I don't know if you need that one.
[AGENT][NEUTRAL] Yes, I need the outpatient, please.
[CUSTOMER][NEUTRAL] Yes, 02164502.
[AGENT][NEUTRAL] And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Yes, uh, [PII] and my email is [PII].
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised the verification of coverage does not guarantee the payment of a claim. And do you have a data service on that previous claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, there were, I did 5 sessions that started like [PII].
[AGENT][NEUTRAL] OK, I'm showing.
[AGENT][NEUTRAL] Looks like a diagnostic test.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] it's pulled up.
[CUSTOMER][NEUTRAL] I, I, you already, I, I submitted a claim for the MRI, right? And then you already, you know, they, they, I, I got the money, and then the doctor recommended to do the rehab. OK, but I didn't do it directly. The doctor's office was going to submit everything.
[CUSTOMER][NEUTRAL] So I just wanna make sure things are done and what is the status.
[AGENT][NEUTRAL] And I don't show any services being received as of the diagnostic on [PII]. And then,
[AGENT][NEUTRAL] Let's see, there is a claim.
[CUSTOMER][NEGATIVE] So they have not submitted anything.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, so I can submit that, right?
[AGENT][POSITIVE] Yes ma'am, along with the primary insurance explanation of benefits, yes ma'am.
[CUSTOMER][NEUTRAL] OK, for um
[CUSTOMER][NEUTRAL] OK, for the explanation of benefits for the
[CUSTOMER][NEUTRAL] Rehab, correct? Because I submitted for the, OK, so you need the, can you please confirm, besides the explanation of benefits, what is the other thing that I need to do or give send?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] You would need to send an itemized bill from that provider.
[AGENT][NEUTRAL] You would need your Medlink claim form, which you can obtain online once you log into your portal, go under forms, and you would need the Metlink claim form and then your primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so once I submit that, with that insurance, because I had, I had I had a co-payment with that one, OK? And then.
[CUSTOMER][NEGATIVE] We changed insurances, so now, when I, I called Aetna, and they told me that they don't cover the rehab until I reach my deductible.
[CUSTOMER][NEUTRAL] So, in that case, I will need to submit it. I mean, it's, it covers, I'm I'm not with these things, so.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, this plan will pick up your co-pays, your coinsurance and our deductibles up to your benefit amount.
[CUSTOMER][NEUTRAL] So with Aetna, it will cover.
[AGENT][NEUTRAL] If Aetna covers, this plan will cover.
[CUSTOMER][NEUTRAL] The rehab.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So, but that's my question. Aetna covers, I have to pay the full amount until I get
[CUSTOMER][NEUTRAL] Until I reached my deductible. And I just started and my deductible is like $7000 so.
[AGENT][NEUTRAL] Yes, and then you
[CUSTOMER][NEUTRAL] In this case,
[AGENT][NEUTRAL] Submit the claims over if there's a covered benefit under this plan, it will pick up that co-pay and deductible up to the benefit amount.
[CUSTOMER][NEUTRAL] Um, because
[CUSTOMER][NEUTRAL] I'm sorry, and I appreciate your patience. Uh, what I, what I don't want is to go and pay because you, I will have to pay the full price, right? For, for the rehab.
[CUSTOMER][NEGATIVE] And then I still have like 5 or 6 more, or 8 more sessions, I think. And what I don't want is to pay everything and then at the end find out that I am not covered.
[CUSTOMER][NEUTRAL] Will that be the case?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?