AccountId: 011433970860
ContactId: 6ce12b0f-a56d-4240-982f-22b30549ff97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314720 ms
Total Talk Time (AGENT): 141188 ms
Total Talk Time (CUSTOMER): 162876 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/6ce12b0f-a56d-4240-982f-22b30549ff97_20250124T17:16_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. Um, I have your, um, APL insurance, and I need to know what do I need to, uh, take, what do I need to get from a doctor's visit so that I could get my, um, uh, deductible payment that I made refunded from your company.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Um, yes, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is 02505772 ML 8.
[AGENT][NEUTRAL] What is your name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Ms. [PII], can you verify your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] [PII] DEE [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much I appreciate that.
[AGENT][NEUTRAL] And was this for a procedure in a doctor's office?
[CUSTOMER][NEUTRAL] No, I'm here to see an endocrinologist and I presented my card for the doctor's visit, um, the payment that I had to make of, of $60 and they wouldn't take your card. They said that you guys didn't cover those, um, you know, reimbursements. I explained to them that you guys did. She says, well, we don't, we have the same insurance here in my office and um we don't take that. I said, OK, no problem.
[AGENT][POSITIVE] Oh my goodness. I am so sorry.
[CUSTOMER][NEGATIVE] Yeah, very rude. Mhm.
[AGENT][NEUTRAL] That is crazy because your policy does cover that and you know it.
[CUSTOMER][POSITIVE] Yes I do.
[AGENT][NEUTRAL] OK. So, what we're going to need, Ms. [PII] from the doctor's office.
[AGENT][NEUTRAL] Is something including your diagnosis codes for that visit. Let me ask you, who's your primary insurance with?
[CUSTOMER][NEUTRAL] Aetna.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you can obtain maybe the
[AGENT][NEUTRAL] Visit summary or
[AGENT][NEUTRAL] Walkout papers, please tell them that we do need something with the diagnosis codes.
[CUSTOMER][NEUTRAL] OK, let me give me a second so I can write this down because all they gave me was a little print out receipt of what I paid. So I, I need a diagnosis, what?
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] A diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anything else that I might need from them or is that good enough?
[AGENT][NEUTRAL] If, if they can give you just a visit summary or something including your procedure and diagnosis code, the procedures like for the visit.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] If they do any
[AGENT][NEUTRAL] Procedures or treatments.
[CUSTOMER][NEUTRAL] Alright, OK, no problem, thank you. OK, I'm sorry, I just walked into the office, I'm, I'm OK. So yeah, visit summary including procedure and what else and and diagnosis code, OK.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] Diagnosis code.
[AGENT][NEUTRAL] Yes ma'am, and then we'll also need a copy of your explanation of benefits from Aetna once they process the claim.
[AGENT][NEUTRAL] And that will show us what they applied to your uh co-pay or deductible.
[CUSTOMER][NEUTRAL] So that's what I have to get from Aetna?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes ma'am, it's called an explanation of benefits.
[CUSTOMER][NEUTRAL] Explanation of benefits. OK, got it. That's the EOB, right? Bets.
[AGENT][POSITIVE] That's right. So once it's processed, then you would submit that um visit summary with the diagnosis codes from the doctor's office and your copy of your EOB from your primary insurance. And next time, if you have any problems like that, if you just wanna give us a call while you're there, maybe we can talk to him and that would change everything. Hopefully. I don't know. I'm so sorry they wouldn't accept that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, they, I mean, I, I understand that they didn't accept because it happened before, the, the, they'll tell you right out, no, we don't accept that, you have to do it on your own or you have to pay, which is not a problem. It was the point where she tells me, we have the same insurance here and we don't, and they don't offer that. I go, ma'am, your policy might not be the same policy as mine. Mine does it. So yeah, well, and that's, yeah.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] And aren't you glad
[CUSTOMER][NEUTRAL] I feel sorry for them because that's the billing person here, so imagine, you know what how what a terrible job she must be doing. So, alright, thank you very much. I just wanted to make sure that I got the paperwork that I needed.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Sure, it's a pleasure and you know you can upload that online on the portal. I see you have an active account.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] It's my pleasure. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Have a
[CUSTOMER][POSITIVE] No, that's it. Thank you very much have a good day.
[AGENT][POSITIVE] I hope you have a wonderful day as well, Ms. [PII]. Thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] Bye bye, bye bye.