AccountId: 011433970860
ContactId: 3a3854b3-8195-494e-b97b-f593c1a6bf88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306880 ms
Total Talk Time (AGENT): 142961 ms
Total Talk Time (CUSTOMER): 132625 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/3a3854b3-8195-494e-b97b-f593c1a6bf88_20250211T20:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I was put in the hospital a few weeks ago for cardiac arrest and wanted to see if any claim had been filed directly. I think my husband gave the hospital both my Aetna insurance and my APL card, but I don't know if anything had been filed or if I need to do it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, well, I can definitely take a look at the policy and see if anything has been received. Now, it's kind of hard to gauge because technically they can file it at any time. So I don't want to, if it's not here, they may still be filing it. Um, Ms. [PII], may I have a good contact number and your policy number?
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Um, contact number is [PII], and let me click here to get my policy number.
[CUSTOMER][NEUTRAL] Just getting the file, bear with me.
[AGENT][POSITIVE] Mhm take your time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And the the payer ID number is 60801 and the policy number.
[CUSTOMER][NEUTRAL] 02551634
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have the policy here. I just need you to verify your date of birth, your mailing, and email address on file.
[CUSTOMER][NEUTRAL] [PII] and then my number is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I'm not showing any claims have have been received yet.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] So, of benefits, so I went into cardiac arrest. Is that something that is covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] For a hospital emergency visit.
[AGENT][NEUTRAL] Were you admitted into
[CUSTOMER][NEGATIVE] I'm really confused on this. Yes, I was admitted for 5 days.
[AGENT][NEUTRAL] OK, so you're not gonna really use the outpatient or the emergency, that's going to be inpatient because you were admitted. So your policy does um pay up to $7500 per calendar year for inpatient uh expenses, so admission, anything that was, you know, while you were in the hospital, it'll, um, it can be paid up to the $7500 per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I was submitted res resuscitated all that so um do I just submit a claim form with that?
[AGENT][NEUTRAL] So when were you in the hospital? Like how long ago was it?
[CUSTOMER][NEUTRAL] About 3 weeks ago.
[AGENT][NEUTRAL] I mean, you can file the claim if you want. I honestly would let the provider because it still has to go through primary. Like, do you have your primary explanation of benefits?
[CUSTOMER][NEUTRAL] From Aetna.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, the claim shows um.
[CUSTOMER][NEUTRAL] To have been filed now and shows the explanation of benefits, so do they file it with you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, yeah, so how it works is after they file or file with Aetna, Aetna processes, the explanation of benefits is sent to the hospital, then they'll automatically bill us as second and they'll send that explanation of benefits over and then the hospital's billing so that we can see if something is owed to you, we can pay it to you, if something is owed to the provider, you know, after primary pays, we can pay to them up to that 75.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, got you, got you.
[CUSTOMER][NEUTRAL] OK, OK, well I will look and see um.
[CUSTOMER][NEUTRAL] Uh, I'll give it a few more weeks and see if that's the case or if I need to file it directly.
[AGENT][NEUTRAL] Yes, ma'am, and then um once we do receive your claim though, um, oh this is how you can know, when we receive their claim, you'll receive a notification saying a claim has been received and is in processing.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] So that'll kinda help you gauge too.
[CUSTOMER][POSITIVE] All righty. Well, I appreciate your help. Yeah, OK.
[AGENT][NEUTRAL] You're welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] No thank you I appreciate it.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Well, thanks for calling APL. I hope you get some rest and happy healing.
[CUSTOMER][POSITIVE] Thank you. Uh-huh. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.