AccountId: 011433970860
ContactId: 55f61dc9-fb2e-43a3-93fd-f2e91bbe4b1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273029 ms
Total Talk Time (AGENT): 84179 ms
Total Talk Time (CUSTOMER): 135719 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/55f61dc9-fb2e-43a3-93fd-f2e91bbe4b1c_20250206T15:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] [PII], hi, my name is [PII]. Do you need my member number or what would be helpful?
[AGENT][NEUTRAL] Oh, a phone number in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 234.
[CUSTOMER][NEUTRAL] 8117.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And can I verify your address and email address?
[CUSTOMER][NEUTRAL] Sure, um, home address is [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] OK. Thank you, Miss [PII]. And you had a question about your policy or claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, a couple of claims. I had two doctor visits in [PII] on the [PII] and one on the [PII].
[CUSTOMER][NEUTRAL] And it doesn't appear as if, well, I guess I'm not understanding the process, does my primary coverage is Aetna, so does Aetna file with you or does the provider file with you?
[AGENT][NEUTRAL] Normally the provider files it with us. It does not cross over from Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Right, OK, so I'm getting, I'm getting conflicting information from the provider. They're saying that Aetna is supposed to do it and now they're saying, and I know that that I, I, yeah, I knew that wasn't right. So what, what do I have to besides these numbers, you know, my policy number and all that, what do I have to give my provider because I have it. Everything's worked fine up until November.
[AGENT][NEUTRAL] No ma'am.
[AGENT][NEUTRAL] Um, normally you would just give them your information and give them your policy number and they'll file it for you. Now, if they don't file it for you, then you can file it yourself. You said [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And the [PII], yeah, there were two different. One was an endocrinologist at Carl Hospital.
[CUSTOMER][NEUTRAL] And the other one was with OSF on the [PII].
[AGENT][NEUTRAL] Hold on just a second.
[AGENT][NEUTRAL] Carl physician group. That was for an office visit, which is not covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, that makes sense.
[AGENT][NEUTRAL] And then the, you said [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] I don't have a claim for [PII].
[CUSTOMER][NEUTRAL] Right, that makes sense because they didn't file it because she's the, that's the, that's the hospital or the doctors that said no, Aetna is gonna do it and I knew that was wrong. So I'm gonna call them back, but if, if they're not willing to file with you, then what happens? I pay them and then I file a claim with you and get reimbursed?
[AGENT][NEUTRAL] Yes, ma'am. We, and, and just ask them if they don't wanna file the claim for you tell them you need a uh itemized bill that has a procedure codes and diagnosis code on it.
[CUSTOMER][NEUTRAL] Procedure codes and diagnostic codes. OK.
[AGENT][NEUTRAL] Uh-huh. And then we would need your explanation, then we would need the explanation of benefits from Aetna to go along with it as well.
[CUSTOMER][POSITIVE] All right, thank you, [PII]. I'm sorry.
[CUSTOMER][POSITIVE] Oh gosh, right, that's a lot of paperwork. All right, thank you. All right, I'll, I'll uh get that worked out. It's 300 bucks, so it's worth the phone call. Thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.