AccountId: 011433970860
ContactId: 65e83e34-35dc-43d0-a557-1a1b468c9ba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382239 ms
Total Talk Time (AGENT): 165996 ms
Total Talk Time (CUSTOMER): 159349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/65e83e34-35dc-43d0-a557-1a1b468c9ba7_20250407T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. My name is [PII], and I hope it's not too late to file a claim or a procedure that I had completed in [PII].
[AGENT][NEUTRAL] OK, yeah, no, you can, should be able to still file claims. Mhm.
[CUSTOMER][NEUTRAL] Like it's still fine? OK, all right, so I'm trying to log in online. I don't recall setting up an account, so I'm on the page. It's telling me that my user information, um, there was an error, so I think it's asking me, I could put in my social, what what is my member, how do I find my member ID number? I'm looking at a copy of my ID card that I got in the mail.
[AGENT][NEUTRAL] Yeah, I mean, your social should work. Um, what's the policy number that you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] If you have a card, it would say.
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] Is the group number the policy number?
[AGENT][NEUTRAL] No, do you see anything that says member certification number?
[CUSTOMER][NEUTRAL] Um, I see benefit certification number.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] Um, it's two different ones. It says in hospital and outpatient.
[AGENT][POSITIVE] OK, yeah, you, you can give me either one.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] OK, I'm gonna give you the outpatient because this is for an X-ray that I had. So it's 0240.
[CUSTOMER][NEUTRAL] 549
[CUSTOMER][NEUTRAL] 3, followed by the letters M.
[CUSTOMER][NEUTRAL] [PII], followed by the number 8.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And then if I can verify the name on the policy.
[CUSTOMER][NEUTRAL] Um, [PII] and my last name is [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And then date of birth and address we should have on file.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[CUSTOMER][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] All right, thank you so much. And then you have a Gmail on file. It looks like it's [PII]. Is that a good email?
[CUSTOMER][POSITIVE] That is, yup, that's correct.
[AGENT][NEUTRAL] OK, so let me see if you've ever created a login for this before.
[CUSTOMER][NEUTRAL] Yeah, I tried my social and it, it says, it appears you may not be eligible to create an account.
[CUSTOMER][NEUTRAL] If this is a mistake, call this number that I'm talking to you on.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like the reason you're getting that errorlaine is because the policy.
[AGENT][NEGATIVE] Status is not showing active.
[AGENT][NEUTRAL] So it would
[CUSTOMER][NEGATIVE] Right, my company transitioned, yeah, transitioned away from Aetna, and so the, there, this product is no longer available as of [PII].
[AGENT][NEUTRAL] OK, so what I'll have to do then is email you a claim form. Unfortunately, once the policy is no longer active, they cannot be done online. You'll have to submit the claim, uh, then back to us. You can do it either via mail or you can do it via fax whatever works best for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so what I'll do if it's all right with you is I can email you the claim form and it'll have instructions on page one as far as what needs to be, uh, accompanying the actual claim form. You'll wanna make sure you have itemized receipt. We'll need explanation of benefits from your primary provider uh we'll need to see exactly what they paid on the date of service and then what the remaining balance was.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I have the EOB from Aetna's uh website.
[AGENT][NEUTRAL] OK, and then the fax number and mailing address are on the claim form, but if you'd like, I can give that to you also if you want to write those down.
[CUSTOMER][NEUTRAL] Sure. What's the fax number?
[AGENT][NEUTRAL] So the fax number is going to be [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll just mark attention to claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, and then the mailing address is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is in [PII] City, [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And zip code is gonna be [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. All right, so just to clarify, I could submit my the EOB statement, right from that I have from Aetna and um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, and do I also need to send a receipt? I have to print it or just the EOB statement.
[AGENT][NEUTRAL] No, you wanna send the itemized statement along with the EOB both.
[CUSTOMER][POSITIVE] OK. All right. Um, the EOB looks pretty itemized to me, but I, let me go find the other item that I got from the doctor's office. OK. All right, very good. All right. Thank you so much for your help and I will watch out for the email.
[AGENT][POSITIVE] OK, yeah, it's on its way and if you have any other questions or concerns please feel free to give us a call OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye now.
[AGENT][NEUTRAL] Bye bye.