AccountId: 011433970860
ContactId: 5b05fe8a-38f3-48ae-9797-d9330a12ebf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503000 ms
Total Talk Time (AGENT): 266306 ms
Total Talk Time (CUSTOMER): 185614 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/5b05fe8a-38f3-48ae-9797-d9330a12ebf6_20250321T14:48_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I submitted um a claim.
[CUSTOMER][NEUTRAL] 2 days ago. And um on the bottom it says that if uh that if I need to uh submit more information for your review to do it, and I just did it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, can, can you check on that? I don't know if I I need to do a new because it was already processed.
[CUSTOMER][NEUTRAL] So I don't know if I need to do it.
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] OK. Uh, if I could get your policy number, [PII].
[CUSTOMER][NEUTRAL] Yes, of course. What's the number.
[CUSTOMER][NEUTRAL] Um, 258-845-7.
[AGENT][NEUTRAL] OK, if you could verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your account. So it looks like we uh asked for the um.
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEUTRAL] The one I'm talking about?
[CUSTOMER][NEUTRAL] It is 725, the one that is the 357-872-5 that was Memorial Hospital.
[AGENT][NEUTRAL] Right. So, are you, are you asking me to take a look at what you sent or you wanted to make sure it was received?
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] No, I see that you guys have it because I'm looking at the website, but I don't know if I need to enter it again as a new claim or I just upload the file.
[AGENT][NEUTRAL] No, no, you did upload it. You uploaded it correctly. So once we take a look at it, we'll know that it's for the claim ending in 725.
[CUSTOMER][NEUTRAL] OK. Oh, so you, you will know which one is for?
[AGENT][NEUTRAL] Yes, ma'am. We, we will know what it is for.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what I downloaded was the after visit summary, uh, when I was released from the, from the hospital, and there is a bill that I got from one of the pathologists from that day, so I don't know, I don't know anything else I can provide.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be the correct information because on the uh discharge summary, it shows what you were being treated for. So we'll be able to take a look at that. As a matter of fact, let me just pull it up and I can let you know for sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] OK, so, yeah, right here it shows.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Let's see the date. So it has the date of [PII] and it has here uh your diagnosis. So, flank plane, kidney stones, urinary urgency. So the information we requested is on here. So once they get to that, um, mail, get to it, um, which is about 2 days from receipt. Um, so we'll, we'll probably review this Monday no later than Tuesday.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And um be able to reprocess your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I get any other bills from that day, should I do the same thing just uh upload them for you guys to see?
[AGENT][NEUTRAL] Now, if you get bills, so if it's for [PII], we'll already have the diagnosis there, um, and it'll already be in the system, so you don't have to resubmit that. Uh, we will at that point just need um the explanation of benefits.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Which is, which you guys have it already too.
[AGENT][NEUTRAL] Yeah, now we already have it for the emergency room claim, so we're not requesting it for this one, but if you receive additional bills, just make sure for this date, for the date of uh your emergency room visit, if you have other doctors that bill you, just make sure you send the explanation of benefits showing what you owe from that, that date and we can process those charges.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You mean?
[CUSTOMER][NEUTRAL] Oh, you mean that whatever I get from that, um, from that doctor for that facility or whatever related to the emergency, I just say what I get.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, right. We, we still will need, you know, the explanation of benefits so we know what, what we're paying, but as far as like having to keep uploading this uh discharge summary, we don't, you don't have to keep sending that.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] No, but if you notice, I also uploaded another one that I got for that day that is from the pathology.
[AGENT][NEUTRAL] Oh, let me take a look at that. Let me take a look at that one.
[CUSTOMER][NEUTRAL] Yeah, it's for the, uh, that's why.
[CUSTOMER][NEUTRAL] That's all I got. So when you say explanation of benefits that I should go to Edna and download whatever they have in their website.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so let, let me just look at what you sent, so I can make sure I'm telling, giving you the correct information.
[CUSTOMER][NEUTRAL] OK, because if, if you need that, then I have to look and and uh and resubmit it.
[AGENT][NEUTRAL] Yeah, we always need the explanation of benefits. So if you get a bill, uh, you need to make sure that they have sent that to Aetna because they are, they pay first, and then you send us, uh, once Aetna has processed the claim and send you the explanation of benefits, uh, yeah, so for this $44 you should have a.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Explanation of benefits that matches this charge.
[CUSTOMER][NEUTRAL] OK, so I just go to it.
[AGENT][NEUTRAL] For your pathology?
[AGENT][NEUTRAL] And send that, yeah, because that's what we pay from. We pay from the explanation of uh benefits from, from uh Aetna. So if you, you know, you can go ahead and get that, see if they have it for this charge.
[CUSTOMER][NEUTRAL] Do, do you mind hold just one second and see if I, if I see it here because I, I'm looking at the end right now.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah, I mean, you can, you can, I can hold or, you know, if you get it, just know if we process, we get to these charges before you send that, we're going to request it. So I would just say if they have it, if they processed this charge where it left you with a $44.10 balance, you want to send that so we can um take care of that charge.
[CUSTOMER][NEUTRAL] I do, I do have it.
[CUSTOMER][NEUTRAL] I, I do have it here, um, so I'm, um, I guess I'm going to send it to you.
[AGENT][NEUTRAL] Yes, you wanna go ahead and upload it. So that way, we'll look at everything together. Uh, so if you have it, yeah, go ahead and, and, and upload that also so we can consider that charge because we will need it before making payment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, but they don't call it, uh, explanation of benefits. They just have it listed. Let me see. Oh no, they do have it as a, as a UB. So yes, I'm gonna, I'm gonna send this to you then. I mean upload it to you right now. So thank you would know that when you see the date, you know what claim is related to, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, yeah, go ahead and do that.
[AGENT][NEUTRAL] Right. We'll know it's all related and all goes together.
[CUSTOMER][POSITIVE] OK. OK. I, I'll do that. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, no. Thank you very much. Have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. You have a wonderful weekend. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye bye.