AccountId: 011433970860
ContactId: 531273a4-4147-44b8-84de-24a00ce0d012
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480250 ms
Total Talk Time (AGENT): 270082 ms
Total Talk Time (CUSTOMER): 194327 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/531273a4-4147-44b8-84de-24a00ce0d012_20250103T15:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have a question, um, and I don't know if, um, hopefully you could answer it, but, so I went to the hospital on [PII], and, um, you know, my, my gap insurance paid for it and everything's fine. Um, however, my, um, I guess my neuro uh neurologist that saw me at the hospital just sent me a different bill of his company first.
[CUSTOMER][NEGATIVE] Neurology, you know, whatever it is, but I guess I called them and they said, no, I know they saw you at the hospital, but, you know, they, they're charging you from his office. I'm like, yeah, but why didn't you guys charge me with the hospital bill? Because that's how my gap insurance got covered. And they said, no, your deductible covered some of it, you have to pay the rest of it. Even though he was seeing, he saw me at the hospital. How does that work?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, OK, alright, um, first, let's get your name and your callback number just in case the call is disconnected so I can help you with that benefit.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Of course. OK. So my name is [PII] Last name [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 2549423.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me look up that policy real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can you verify your date of birth for me please, ma'am?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then also I'll need for you to verify your address, phone number, and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, my um address is [PII].
[CUSTOMER][NEUTRAL] And then what did you ask me for? I'm sorry.
[AGENT][NEUTRAL] That's OK, yeah, um, your email address?
[CUSTOMER][NEUTRAL] Yes, I believe it's my work email [PII]. Is it that one?
[AGENT][NEUTRAL] OK, thank you, yes ma'am, that's correct and then the phone number that you gave me to call you back on in case the call is dropped, is that your cell phone number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, thank you so much for verifying this for me. So you received a bill from the neurologist and.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] It didn't go in with the hospital bill, the billing separately from the physician's office, is that correct?
[CUSTOMER][NEUTRAL] Correct, correct, but it says on the, on the, on the bill that it was the same day, [PII], which is the same day that I went to to the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so, um, did you pay any type of deductible copay or?
[AGENT][NEUTRAL] Insurance on that bill?
[CUSTOMER][NEUTRAL] Well, no, I didn't, but my Aetna, my, my other insurance paid for the adjustment. So the bill was 5896 and my Aetna paid $411 so I only owe 184.
[AGENT][NEUTRAL] OK um what I can suggest is for you to send in the claim yourself.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Normally you know like the hospital helps you do that, but if you want to send in the claim yourself to see if any anything would be covered um with the difference, you can do that um let me give you the website to get the claim format it is [PII] like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you go to that website you're gonna you're gonna choose the option in the top right hand corner it says claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the form you're going to need is the Medlink form. It's M E D L I N K. That's on the second page of claims and forms and I believe it's the second one down. So that's the claim form that you'll need to fill out. You'll need to send in your EOB from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your automized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That has the diagnosis and procedure codes on it.
[AGENT][NEUTRAL] Along with your claim form.
[CUSTOMER][NEUTRAL] OK, where would I get that? I guess through Aetna?
[AGENT][NEUTRAL] The EOB.
[CUSTOMER][NEUTRAL] Will I get that through?
[AGENT][NEUTRAL] Yeah, the EOB will come from Aetna and the itemized statement, the itemized statement comes from the physician's office. So the neurology office that you went to should be able to give you an itemized statement with your procedure and diagnosis codes on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Procedure and I and it's not the bill, right? It's not the bill that I got.
[AGENT][NEUTRAL] It's uh it's a right, it's a, um, it's called an itemized statement.
[CUSTOMER][NEUTRAL] It's a different thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Automize autoomize OK, got it.
[AGENT][POSITIVE] Itemized, yes, so you should be able to get that. You'll send, yes ma'am. Yes, you got it.
[CUSTOMER][NEUTRAL] Autom itemize, I'm sorry, itemized.
[CUSTOMER][NEUTRAL] OK. Sorry, sorry.
[AGENT][POSITIVE] And if you send those, no, you're fine, you're fine. Especially when something's new to you, you did good.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] And um you're welcome. So you send those three things in together let me give you, OK, there's there's.
[AGENT][NEUTRAL] Two, well 3 different ways you can send it in. The first way is the way that I would suggest for you to do it is to sign up on the online service center if you're not already signed up. Let me give you that that website. OK good you can send it in through through there because your information numbers from from there when you send the claim in that we've received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I'm already up in the website.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, of course, so, so it's, uh, excellence, mhm, I'm sorry, go ahead.
[AGENT][NEUTRAL] If you have
[AGENT][NEUTRAL] If um you have any troubles with it or you get stuck or whatever and decide that you wanna mail it in, let me give you the address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, we also have a fax number if you did you wanna fax it in let me give you the fax number so you have all the information.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 342-3. OK, just to go back, um, so when we get the form I fill that up and then I have to get the explanation of benefits and that's through Aetna and then an itemized statement and you told me that it has to have a procedure code, right?
[AGENT][NEUTRAL] Yes, the procedure and diagnosis codes on it.
[CUSTOMER][NEUTRAL] And diagnosis code. Got it. And then I said all that.
[AGENT][POSITIVE] And when you talk to them, they'll know exactly what you're talking about. Yes.
[CUSTOMER][NEUTRAL] OK, perfect. Alright, so with those three things, the, the form, the EOB and AS statement, OK, got it. Alright.
[AGENT][NEUTRAL] OK, is there anything else I
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Very welcome. Is there anything else that I can help you with? OK, um, also, if you get stuck, if.
[CUSTOMER][NEUTRAL] No, I think
[CUSTOMER][POSITIVE] Nope, I think you answered all my questions.
[AGENT][POSITIVE] You're very welcome and if at any time you're stuck or you feel like you need more help, just pick up the phone and call us and we'll help you, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. I really appreciate it.
[AGENT][POSITIVE] OK, you're welcome you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you so much bye bye.
[AGENT][NEUTRAL] Mm