AccountId: 011433970860
ContactId: 61f18598-4e02-431b-9b77-4460925b679b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351239 ms
Total Talk Time (AGENT): 106937 ms
Total Talk Time (CUSTOMER): 108392 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/61f18598-4e02-431b-9b77-4460925b679b_20250415T14:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was trying to um check the status of my claim online and I keep, I keep getting a technical error message and it said to call this number.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, I don't. Can you pull it up on my social?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] What is this? It's [PII].
[AGENT][NEUTRAL] OK, let's see. And what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] Uh, I just need to verify a few pieces of information. Your date of birth.
[CUSTOMER][POSITIVE] Uh, this is no problem.
[CUSTOMER][NEUTRAL] Is mine is [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then lastly just your email address.
[CUSTOMER][NEUTRAL] Um, I believe you guys have my personal email which is [PII]. If that's not what you have, I can give you my work.
[AGENT][NEUTRAL] OK, no, that's what we have.
[AGENT][NEUTRAL] And who are we checking on a claim for?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Um, it's my son, [PII].
[AGENT][NEUTRAL] OK. Um, let's see.
[AGENT][NEUTRAL] OK, it looks like
[AGENT][NEUTRAL] We need the primary explanation of benefits from the, your major medical insurance.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Also, we needed the fully itemized billing with diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, is that not on the document that I sent? felt like it might have been not definitely not the EOB, um, but I can get that sent over.
[AGENT][NEUTRAL] OK, let me see what we received.
[AGENT][NEUTRAL] I'm pulling it up. Just give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And so I'm gonna have like probably 7 different EOBs because I keep getting all these bills like I'm getting an emergency room bill, an anesthesiology bill, a lab bill, hospital bill. Do you want all of those?
[AGENT][NEUTRAL] Yeah, so what we received, um, it looks like you sent a patient balance summary.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And none of this has coding on it, so because we have to have the actual codes.
[AGENT][NEUTRAL] So, usually, what's the easiest way to do that is to get the actual claim forms from the hospital, um, if they'll provide those to you, which they they should, um, but we have to have the actual procedure codes and the diagnosis codes.
[AGENT][NEUTRAL] So there's certain they're like numerical, they're alpha numerical codes.
[CUSTOMER][NEUTRAL] OK, and the hospital will provide those to us?
[AGENT][NEUTRAL] Yes, um, you'll want to ask for the actual claim that they submitted to your major medical insurance.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Um, they're called UBO4s, and then we definitely need the um primary explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like Aetna, is that your primary?
[CUSTOMER][NEUTRAL] Yeah, I can do that easily on my app. Um, I've got something from the hospital, something from a physician. I can download all of those EOBs for Keenan and upload them. Once I have the claim open. Can I just upload more documents to the same claim?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] OK, and then I'm gonna attempt to call the hospital and ask them for what they submitted to my insurance company, correct?
[AGENT][NEUTRAL] Yes, the the actual claim that they submitted to Aetna is what you need. Tell them that's what's required for your secondary policy, so we can pay the claim.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Alright, I will try to get them on the phone now.
[AGENT][NEUTRAL] OK. All right. Anything else I can help with today?
[CUSTOMER][POSITIVE] That's all thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.