AccountId: 011433970860
ContactId: 36bba128-2932-4a86-a17d-0acbd6b678a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851299 ms
Total Talk Time (AGENT): 295429 ms
Total Talk Time (CUSTOMER): 474832 ms
Interruptions: 24
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/36bba128-2932-4a86-a17d-0acbd6b678a3_20250218T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I wanted to know if you can help me, um, I wanted to know if something would be covered for my daughter.
[AGENT][POSITIVE] Yeah, we can definitely take a look. Do you have your policy number?
[CUSTOMER][POSITIVE] Um, I can pull it up. Give me one second, thanks.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wait, let me
[CUSTOMER][NEUTRAL] Where is who is that?
[CUSTOMER][NEUTRAL] Who is that?
[CUSTOMER][NEUTRAL] With, with who?
[CUSTOMER][NEUTRAL] I have 0106 hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm still yeah, no, I'm still here 0106.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] 0106 then it's 6915.
[CUSTOMER][NEUTRAL] He cheated on? He cheated on.
[AGENT][NEUTRAL] OK, let me pull this up here.
[CUSTOMER][NEUTRAL] Not that one.
[AGENT][NEUTRAL] And then if I could verify please your first, last name, date of birth.
[CUSTOMER][NEUTRAL] Um, I'm sorry, my date of birth is [PII], but this is under my husband. Is that OK? Or do you need his information?
[AGENT][NEUTRAL] Yeah, no, that's fine. I just need to verify one of the insured on the policy, so I just need name, date of birth, address.
[CUSTOMER][NEUTRAL] OK. Oh, OK.
[CUSTOMER][NEUTRAL] OK, [PII] [PII].
[CUSTOMER][NEUTRAL] And their address is [PII].
[AGENT][POSITIVE] Thank you so much [PII] and then the email address it looks like is yours, [PII] is that still a good email for you guys?
[CUSTOMER][NEUTRAL] no
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for your daughter, what are you looking to see um if it would be covered under the, the plan under the secondary?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] She's getting um some planillas for her flat feet like the full inserts.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Oh, so like a um
[AGENT][NEUTRAL] Like a lift in a shoe?
[CUSTOMER][POSITIVE] Yes. I have no problem.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] So yeah and then.
[CUSTOMER][NEUTRAL] Can you go back up to.
[CUSTOMER][NEUTRAL] Yeah, so keep that yeah.
[CUSTOMER][NEUTRAL] I hope you go back to the
[CUSTOMER][NEUTRAL] the thing that you just uh.
[CUSTOMER][NEUTRAL] What the.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] I'm just scrolling through your policy here, so give me just I apologize for the wait.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Can.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Let me do it.
[AGENT][NEUTRAL] So you have this, I don't know. I need to see what the age limit on it is. I don't think that that would apply here. I'm sorry, I'm talking to myself.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I don't want
[CUSTOMER][NEUTRAL] that's
[CUSTOMER][NEUTRAL] you.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Wait, wait.
[CUSTOMER][NEGATIVE] No, I do not like.
[CUSTOMER][NEUTRAL] What, what
[CUSTOMER][NEUTRAL] I'm trying to pull out.
[CUSTOMER][NEUTRAL] that's.
[AGENT][NEUTRAL] So they had this added thing on here for like newborn care, and it does talk about that it does cover um
[CUSTOMER][NEUTRAL] I like and then.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, me and the.
[AGENT][NEUTRAL] Any sort of like treatment or services or medical supplies recommended by a physician. And so that would fall under, it looks like outpatient. I was looking to see if there was any sort of like limitations though because she is still a child, but obviously not a newborn, you know what I mean?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right, right, mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah well
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, like.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] I she she's gonna jump.
[CUSTOMER][NEGATIVE] What the fuck you.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, so unfortunately it doesn't fall under that specific category because that quote unquote term like newborn is only valid for 18 months after they're born, so it doesn't unfortunately apply to this situation.
[CUSTOMER][NEUTRAL] What you guys.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Um, looking at, yeah, I mean, looking at the, uh, benefits on the plan, most of these benefits are just going to be for, um, physician office visit, any sort of hospitalization, those types of things. I don't see any coverage for like medical equipment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, can I also ask you something else, um, for [PII]? She had her tonsils taken out. I don't know if that was covered with, um, APL. I don't know if they ever billed APL or not. Can you check for me if the claim was processed?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm gonna bring you.
[AGENT][NEUTRAL] Yeah, it was for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you remember when it occurred, like around what time, month or year?
[CUSTOMER][NEUTRAL] I can give you the date if you give me one minute. Yes, can you hold on one second.
[AGENT][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Wait, I can't find it. What do you do here? 67.
[CUSTOMER][NEUTRAL] It was in November. I'm trying to open up my Aetna app, but it was [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] I wanna say like before [PII].
[AGENT][NEUTRAL] Around the [PII].
[CUSTOMER][NEUTRAL] I think so, yeah.
[AGENT][NEUTRAL] Let's see because I see a claim for the [PII] and the [PII] for her.
[CUSTOMER][NEUTRAL] Why is he
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I think it was the [PII].
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] That's [PII]ot working.
[AGENT][NEUTRAL] OK, so there was a claim submitted for date of service [PII]. It was denied only we were requesting the explanation of benefits from the primary, which is pretty standard.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] The explanation of benefits.
[AGENT][NEUTRAL] So that just needs
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From, so from who built that? Is it from the doc from Doctor [PII] or is this from Ostraauer?
[AGENT][NEUTRAL] The claim that I see for [PII] for [PII], the provider is listed as Memorial, I believe division looks like maybe a hospital.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes, OK, that's where she was operated in.
[AGENT][NEUTRAL] So they it looks like submitted the claim to us and then we denied it requesting the explanation of benefits from your primary insurance that's a standard protocol because we need to know what your primary insurance paid so then we're covering the difference.
[CUSTOMER][NEGATIVE] Oh, you're fucking pizzas.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] There's um.
[CUSTOMER][NEUTRAL] OK, OK, alright, so nothing was processed through you, uh, so I have to talk to Aetna, my primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or do I need to talk to the hospital?
[AGENT][NEUTRAL] Well, you can contact the.
[AGENT][NEUTRAL] Yeah, I mean you can contact the provider themselves, the hospital, and let them know that there was a claim submitted that needs the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or you can submit it yourself online, um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, how do I do that?
[AGENT][NEUTRAL] Um, have you ever logged in online? Have you ever used the online service portal?
[CUSTOMER][NEGATIVE] I tried but I couldn't connect. I, it wouldn't um.
[CUSTOMER][NEGATIVE] Like when I would put the policy number, it didn't work and it said it wasn't the policy number it's like some other number and I, I couldn't find it on the card.
[CUSTOMER][NEUTRAL] I have a.
[AGENT][NEUTRAL] Did you try putting in [PII]'s social instead?
[CUSTOMER][NEUTRAL] He didn't wanna put his social. He wanted to use the account number. Do you have the account number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I you.
[CUSTOMER][NEUTRAL] just the.
[AGENT][NEUTRAL] Let me get you the member ID. Give me just a second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And when you did it, [PII], you put in the 01066 number it didn't take it.
[CUSTOMER][NEUTRAL] No, is there a different number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah member ID on here. I'm looking to see if I can find a member ID. I don't see one yet, um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I just see a customer number I can give this to you try this and see if this will work for you because there's um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8099.
[CUSTOMER][NEUTRAL] OK. Also, can you check another claim, but this one's for myself?
[AGENT][NEUTRAL] Mhm. Yeah, what was the date?
[CUSTOMER][NEUTRAL] It was, uh, let me see.
[CUSTOMER][NEUTRAL] It was the end of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You had a claim [PII] looks like for an ER visit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, yeah, yeah, it looks like the provider submitted the claim and they were paid.
[CUSTOMER][NEUTRAL] Was that processed through you?
[CUSTOMER][POSITIVE] OK, all right, thank you so much. I think that is it. I appreciate all your help. I'm gonna look into that one for [PII] and see if they can provide the explanation of benefits for you guys.
[AGENT][POSITIVE] OK. Yeah, sounds good. Anything, anything else I can check on?
[CUSTOMER][NEUTRAL] And resubmit it. OK, that's.
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Right