AccountId: 011433970860
ContactId: 8fe74a02-c956-4108-ae65-2270358b8f26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 677780 ms
Total Talk Time (AGENT): 350748 ms
Total Talk Time (CUSTOMER): 295096 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/8fe74a02-c956-4108-ae65-2270358b8f26_20250205T20:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII].
[AGENT][POSITIVE] Good afternoon, Mr. [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] Uh, I'm good, I'm good. I need a help for my account, please. Can you check my, my account? Uh, I'll tell you my Social Security for I'll check my account, please.
[AGENT][NEUTRAL] Alright, let me get to the screen. I am ready for that num the social security number.
[CUSTOMER][NEUTRAL] OK, spelling [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And can you verify your date of birth, please, sir?
[CUSTOMER][NEUTRAL] Yes, my birthday is on [PII].
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] [PII]. Thank you. And what about your home address?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, give me one second. I'm gonna change my address.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, I spell [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And what is a good callback number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, 1 2nd.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And Mr. [PII], we do not have an email on file for you. Would you like for me to add in the email?
[CUSTOMER][NEUTRAL] Uh, no, but I need help. I need to put with uh my personal assistant for, for help, this name is [PII]. So I can talk now. Can you help me with talk to my personal assistant, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] As long as you give me permission to speak to [PII], I can speak to her on this phone call.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, gracias. [PII].
[CUSTOMER][NEUTRAL] Um, hello?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] with APL. How are you doing today?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, good. I've called before, but they always tell me, and he told me that at at the beginning he put me on the on the on his account, but
[CUSTOMER][NEUTRAL] No, so he, he, um, Mr. [PII], I am his assistant at Adriana Oyos, his company, and he wants to know what is the status on the last claim we submitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can help you with that, since I do have his permission to speak with you. Um, [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Can you put me on the account so next time I call for him, they don't give me a hard time, [PII]?
[AGENT][NEUTRAL] What I can do is on our website at [PII] there is an authorization form under the claims and forms section, and he can sign that and send that to us and that would give us permission to speak with you about him being on the call.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, that would be fine. Yeah, we'll do I'll make them do that now that I have them here.
[AGENT][POSITIVE] OK, yeah. That's the easiest thing.
[CUSTOMER][NEUTRAL] Cause if not, forget it.
[AGENT][NEUTRAL] Yeah, it's just an authorization form that he fills in gives us your information and then we have it on file we won't have to have it for each him for each call.
[CUSTOMER][POSITIVE] Oh, awesome. OK.
[AGENT][NEUTRAL] OK, and I can help you with that claim information now we did receive a claim on [PII] and it was processed on the [PII]. This was for data service [PII] and [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But in
[CUSTOMER][NEUTRAL] Let me see. Yeah, from Baptist Health.
[AGENT][NEUTRAL] Right. Now, in order to complete the processing, we're going to need fully itemized bill with diagnosis codes and procedure codes, and then we'll need a copy of the explanation of benefits from his primary insurance. [PII], this is a secondary policy to his primary.
[AGENT][NEUTRAL] And the policy only pays towards sickness or injury, so we have to have a fully itemized bill with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, it was, uh, I'm sorry, sweetie. It, I do have the service code on the bill from [PII].
[CUSTOMER][NEUTRAL] And the ECD, I don't know what that means.
[AGENT][NEUTRAL] What we need is the ICD code. Is it I as in India? ICD?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, E as in echo, C O CD and then I have a service code which is PSC. I think it was a CAT scan for his back, for his, um, he was having a lot of pain in his back.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] In his lower back
[CUSTOMER][NEUTRAL] So I can send it to you, but I did send it along with the paperwork for the claims.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Let me get that pulled up what was sent. Bear with me just a second. Let's take a look.
[CUSTOMER][NEUTRAL] Yeah, cause we sent it to [PII], I believe. That was the [PII] that I was told. Uh-huh.
[AGENT][NEUTRAL] 4 yeah.
[AGENT][NEUTRAL] That's right. Let me get this document pulled up and
[CUSTOMER][NEUTRAL] And I did send the bill from Baptist Health.
[AGENT][NEUTRAL] Let me check. Yeah, and unfortunately, on the bills, they don't put the diagnosis codes.
[AGENT][NEUTRAL] Nor the procedure codes. I'm not sure what that service code is, that's probably something to do with their facility.
[CUSTOMER][NEUTRAL] Let me write it down. What was that again? Procedural codes?
[AGENT][NEUTRAL] We need the uh procedure codes and diagnosis codes.
[AGENT][NEUTRAL] Who is his primary insurance with?
[CUSTOMER][NEUTRAL] Aetna.
[AGENT][NEUTRAL] Aetna, yeah, see, they don't put that information on their EOBs either. So, and let me ask you, the Baptist, did he provide his APL ID card to [PII] because normally they.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Submit claims.
[CUSTOMER][NEUTRAL] I would have to ask him. He just stepped out again. He'll be back. I'll, I'll ask him, but if he did not,
[CUSTOMER][NEUTRAL] Should I just call Aetna and, and, and for them to provide me with the procedure and diagnosis codes or Baptist? Aetna?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. Let, let me, OK.
[AGENT][NEUTRAL] So for [PII] you can call them and ask them for a uh a form. It's called a UB04 that's U as in umbrella, B as in Bravo 04, a UBO4 for both dates of service, and that will have all the codes needed that we need to for from [PII]. Now from from Aetna.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do, do you know if he has an online account with Aetna?
[CUSTOMER][NEUTRAL] Online
[AGENT][NEUTRAL] Yeah, because a lot of times you can create an an account on a portal.
[CUSTOMER][NEUTRAL] I don't think so. I have his group number and his user number. I have the group number if that helps and the and the issuer. I mean, you want the group number for uh.
[AGENT][NEUTRAL] OK, so what I would do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now that, that what we need is the explanation of benefits from Aetna where they process the claim.
[CUSTOMER][NEUTRAL] Right. Do you have?
[CUSTOMER][POSITIVE] OK, [PII], you've been very helpful. Do you have a number that I can call [PII] right now to, to order these? See if I can get them?
[AGENT][NEUTRAL] I don't know if that was, let me pull that back up on the claim.
[AGENT][NEUTRAL] Do you have the bill right there?
[CUSTOMER][NEUTRAL] Yeah, yeah. I have it in front of me. Let's see, receipt number, payment, let me see if there's a number and I'm not looking at it.
[CUSTOMER][NEUTRAL] He paid out of pocket. Uh mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Receipt details, no telephone number.
[AGENT][NEUTRAL] No telephone number on here.
[CUSTOMER][NEUTRAL] No, I have the receipt number. Maybe if I call back to, they can help me with that, right?
[AGENT][NEUTRAL] Yeah, call [PII] at the um the billing department to get that UBO4 from them, and then you would call Cigna and ask them for an explanation of benefits or an EOB, which stands for explanation of benefits for those two dates of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can either fax it.
[AGENT][NEUTRAL] To our
[CUSTOMER][NEUTRAL] I don't, I don't have a class. I can scan it.
[AGENT][NEUTRAL] And he doesn't have a portal account with us.
[CUSTOMER][NEUTRAL] No. So the diagnosis is an EO4.
[AGENT][NEUTRAL] Uh, the, the diagnosis and what you'll ask from [PII] is UBO4, U as umbrella, B as in 4. That's from [PII], and from Aetna, the
[CUSTOMER][NEUTRAL] Mhm. OK, that's all. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can I email it to you? Do you have an email?
[AGENT][NEUTRAL] Our email is not secure. We definitely um prefer not receiving personal health information via email due to that fact because we do want to protect his information.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'll just send it to the same PO box of [PII].
[AGENT][POSITIVE] Mhm. That's right. And be sure to get that Aetna EOB as well.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] What is the EOB? I'm requesting this from them.
[AGENT][NEUTRAL] From Aetna, you will ask them for the explanation of benefits or explanation of EOB stands for explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[AGENT][NEUTRAL] And for each data service for the 1125, 24 data service.
[AGENT][NEUTRAL] And the 91624 data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so that I don't have to request that I'm from Baptist, I'm sorry, [PII] that I'm repeating this, but these are codes that I've never dealt with this before. So I'm calling Baptist and requesting the UBO4 and then from Aetna, I'm calling for EOB on both dates.
[AGENT][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's right. You got it. Good job, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, sweetie. Thank you so much. Thank you. God bless. You have a great day. Yeah.
[AGENT][POSITIVE] It's such a pleasure to assist you.
[AGENT][NEUTRAL] You too, [PII], and then that authorization form is on our website at [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] under the claim forms.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Very well.
[CUSTOMER][POSITIVE] OK. Awesome. Thank you so much, [PII].
[AGENT][POSITIVE] It's been my pleasure, and y'all call if we can be of further assistance. I hope you'll have a lovely afternoon.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you. You as well. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.