AccountId: 011433970860
ContactId: 2de392c0-fac1-46ef-9b39-e052bec2faff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449399 ms
Total Talk Time (AGENT): 162155 ms
Total Talk Time (CUSTOMER): 124878 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/2de392c0-fac1-46ef-9b39-e052bec2faff_20250409T13:29_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, hi, I just got, um, the explanation of benefits for my claim, and I'm still not understanding it because it's asking for additional information that I provided.
[AGENT][NEUTRAL] OK, let's see, um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh, my first name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My last name is [PII]
[CUSTOMER][NEUTRAL] And I'll give you my cell number is [PII].
[AGENT][NEUTRAL] And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 01616293.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for security I need to verify your date of birth, mailing address and email address on file.
[CUSTOMER][NEUTRAL] Uh, uh, [PII], um, [PII], and I'm sorry, what was the third one?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] The email address.
[CUSTOMER][NEUTRAL] 00, which one do you have on file? Um, I, if it's my [PII], it's [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Yes, thank you. mhm alright uh let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me pull this [PII] one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still waiting on the system for the documents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] More than I please diagnosis.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, based on the note, it looks like it doesn't have the diagnosis code.
[CUSTOMER][NEUTRAL] The diagnosis code, uh, for my, I'm just specifically talking about the MRI bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um.
[CUSTOMER][NEGATIVE] Um, I don't care about anything else.
[AGENT][NEUTRAL] Yeah, yeah, it's just not giving us the diagnosis code. The diagnosis code is the reason why you had to have that, uh, um, test done. Um, we do see the procedure, which is the test, but we don't see the diagnosis why you had to have that test done. So that is what we're trying to determine and that's why we need the diagnosis.
[CUSTOMER][NEUTRAL] Well, that's why I prov uh OK but that's why I provided the ultrasound test results which required me to have the MRI.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, um, but that doesn't really tell us if it was because you had abdominal pain, headaches, um, is the diagnosis is telling us why you had to have those tests done.
[AGENT][NEUTRAL] And that's what we don't have. So we just need the diagnosis.
[CUSTOMER][NEUTRAL] And how do, how do I get that? How do I get that?
[AGENT][NEUTRAL] Um, you, you can contact the provider of service and ask them to, uh, send you something with the diagnosis code.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, well, the, the provider of record is the lab.
[CUSTOMER][NEUTRAL] I, I don't know because he would.
[CUSTOMER][NEUTRAL] I mean, he, the code on the bill is not my doctor. He's the one that I guess reviewed the MRI he wasn't the one that sent me for the MRI so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How, um, OK, I don't, I don't understand, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They should have records, all the tests or anything that they do in a provider's office or anything they do in general. If you go to visit any doctor, they need to have diagnosis codes. So, um, he must have records.
[AGENT][NEUTRAL] Of the diagnosis code. You just need to ask him if he says, oh, I don't have it, you have to go back to your doctor, then you probably have to go back to your doctor, but usually they have that information. You just need to ask them for a fully itemized bill with the diagnosis codes.
[AGENT][NEUTRAL] Because they, they need to know why they're doing the test. So they have that diagnosis code. They cannot do a test without knowing why.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but Aetna paid part of it already, right? So.
[CUSTOMER][NEGATIVE] This is what's so confusing.
[AGENT][NEUTRAL] Yeah, and, and that doesn't have the diagnosis codes on their explanation of benefits. Um, there's some, um, companies that do like Blue Cross. They're really good because they have everything on their explanation of benefits, but ENDA doesn't have that information here, and that's why we're not able to get it from the explanation of benefits from Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have to figure out how to contact this doctor that I don't even know. OK, great, thank you. I'll try to get it.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're welcome, Miss. I'm so sorry. Is there anything else I can help you with today? You as well.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] No thank you very much I appreciate it.
[AGENT][POSITIVE] Mhm. You're welcome. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] OK bye bye bye you too bye.
[AGENT][POSITIVE] Thank you.