AccountId: 011433970860
ContactId: 5c6d3a31-8816-4f1a-adb1-0fa16cd9fec1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486989 ms
Total Talk Time (AGENT): 190145 ms
Total Talk Time (CUSTOMER): 191029 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/5c6d3a31-8816-4f1a-adb1-0fa16cd9fec1_20250424T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I recently submitted a claim and it was over the weekend. And I just want to make sure that I sent everything in that I needed to send in, or if you needed anything additional, or any explanation of what I sent in.
[AGENT][NEUTRAL] OK. Uh, do you have your policy number handy?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Uh, would it be in the hospital benefit certificate number?
[AGENT][NEUTRAL] Yes, that'd be it.
[CUSTOMER][NEUTRAL] OK, 024062.
[CUSTOMER][NEUTRAL] 66 ML 7
[AGENT][NEUTRAL] OK, Missy, um, do you have, what is your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, let me try that number one more time. I think I may have got a number off. Um, if you don't mind, will you give that to me again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Um 024.
[CUSTOMER][NEUTRAL] 062.
[CUSTOMER][NEUTRAL] 68 ML 7
[AGENT][NEUTRAL] OK, perfect. Um, just need to verify a few pieces of information. Um, do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then what is your address?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, looks like I have a different address. So [PII] address.
[CUSTOMER][NEUTRAL] Is it, yeah, the [PII]?
[AGENT][NEUTRAL] OK, so that, that is the old address.
[CUSTOMER][NEUTRAL] Yeah, I've, I've very recent.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and what's your email address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and let's get your address updated, um.
[AGENT][NEUTRAL] You do want to change it, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, perfect. OK, and will you give that to me again, please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then [PII]
[CUSTOMER][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, we got that updated. Let me get that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, just wanna repeat it back to you, make sure I didn't miss anything. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, perfect. Great. OK. And we're checking to see, you said you submitted a claim, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see what we have here.
[AGENT][NEUTRAL] OK, it looks like, so we did process the claim, but it looks like we do need the explanation of benefits that we received did not list if there are any amounts applied to the deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] So we do need to see that um explanation.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I put on there my visa.
[CUSTOMER][NEUTRAL] Uh, in my Visa card, and it shows that I paid Casa Palmera, uh, I think it was 3000 something.
[CUSTOMER][NEGATIVE] Um, and then I also, and, uh, she actually just called today and I have to pay an additional, uh, 2800 sum.
[AGENT][NEUTRAL] OK, um, it looks.
[CUSTOMER][NEUTRAL] I can send you the email if you'd like for that.
[AGENT][NEUTRAL] Yeah, it looks like what we actually need though is the the EOB, the explanation of benefits. Let me see what we have here. So it looks like you sent a
[AGENT][NEUTRAL] The screenshot maybe.
[AGENT][NEUTRAL] From your uh phone maybe March, it said [PII] statement explanation of benefits.
[AGENT][NEUTRAL] I have the amount billed, the discount, um, pending or not payable by plan. We just have to break down what your share is. If, if that share that 6,159, if that's a deductible, if that's your co-insurance, that's, that's what we were looking for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, it's the, it's the deductible. It was the remaining deductible on my Aetna policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have something that shows that that says deductible?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's usually
[CUSTOMER][NEUTRAL] Don't know what exact.
[AGENT][NEUTRAL] You, um, do you have like, so when you log into Aetna, usually it'll have like a PDF file and you can pull it up and it'll have like a breakdown, and it'll show in columns, it'll show like deductible amount, 6000 coinsurance, 159. I'm just spouting out an example but um so that's that's what we were looking for.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that that it's in a, a deductible?
[AGENT][NEUTRAL] Yes, and it specifies how your portion, how it was, you know, allocated, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, let me, let me look around, see if I can, I don't, cause I sent you the explanation of benefits. So I'm not sure where else, where else to look.
[CUSTOMER][NEUTRAL] Um, to find that. Um,
[AGENT][NEUTRAL] Um, you might
[CUSTOMER][NEUTRAL] I guess I'll just go look a little bit through the Aetna file.
[AGENT][NEUTRAL] Yes, I, uh, if you have an Aetna account, I'd log into there and like I said, they should have an actual full.
[AGENT][NEUTRAL] Explanation of benefits that shows, like I said, the breakdown of what went towards your deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, uh, let me look and then if I find it, um, should I put, I guess, screenshot it and send it to you?
[AGENT][NEUTRAL] Yes, that'd be fine. Yeah, you can just upload it again and then we'll, we'll get it um attached to this claim and then we should be able to continue on processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, sounds good. Thank you for your help.
[AGENT][NEUTRAL] OK. Anything else I can help with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good afternoon.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you.