AccountId: 011433970860
ContactId: 95dd98c0-d664-4fac-8fce-9951cae9e777
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557719 ms
Total Talk Time (AGENT): 302491 ms
Total Talk Time (CUSTOMER): 309199 ms
Interruptions: 20
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/95dd98c0-d664-4fac-8fce-9951cae9e777_20241230T17:46_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] The
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Good morning. How are you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Good, good. I'm calling because I'm here at a doctor's visit for my daughter.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um they're asking me to do a co-payment.
[AGENT][NEUTRAL] OK and
[CUSTOMER][NEUTRAL] But they're telling me that the insurance is not covering it, so I just wanted to double check.
[AGENT][POSITIVE] Well it would be my pleasure to assist you. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Give me 1 2nd, let me look it up.
[AGENT][POSITIVE] All right. Take your time.
[CUSTOMER][NEUTRAL] I have the group number?
[AGENT][NEUTRAL] At the bottom of the card, do you see the outpatient benefit certificate number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's your policy number. Mhm.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 024651
[CUSTOMER][NEUTRAL] 64 ML 8.
[AGENT][NEUTRAL] Thank you. And your name and date of birth, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The [PII], [PII].
[AGENT][NEUTRAL] Can you verify your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] [PII] and the email address, I'm not sure which one you guys have on file.
[AGENT][NEUTRAL] Uh, looks like we have your Gmail.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] It's either [PII] or
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] That's the one we have. Thank you. And what is your callback number?
[CUSTOMER][POSITIVE] OK, cool.
[CUSTOMER][NEUTRAL] Um, the callback number is [PII].
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] And then put it off and then the source.
[AGENT][NEUTRAL] So I'm checking now the policy number you gave me is no longer active.
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As of [PII]. I do have an active policy number for you.
[CUSTOMER][NEUTRAL] Give me 1 2nd so I can write it down.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $200 American.
[CUSTOMER][NEUTRAL] Public.
[CUSTOMER][NEUTRAL] So, it wouldn't cover today?
[AGENT][NEUTRAL] I'm checking that for the is it for an office visit?
[CUSTOMER][NEUTRAL] Although it's not.
[CUSTOMER][NEUTRAL] No, it's for a special um a specialist.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It's for a specialist, yeah.
[CUSTOMER][NEUTRAL] December.
[AGENT][NEUTRAL] Let me just get that pulled up real quick for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, I'm ready for the policy number if you have it.
[AGENT][NEUTRAL] I do, and I can also email you a copy of the card as well.
[CUSTOMER][POSITIVE] Awesome, perfect, yes.
[AGENT][POSITIVE] It be my pleasure. So the policy number that is active is 165.
[CUSTOMER][NEUTRAL] I was told I didn't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9502.
[AGENT][NEUTRAL] And this policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK, so this would be the policy number?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, let me repeat it just in case 1659.
[CUSTOMER][NEUTRAL] 502.
[AGENT][NEUTRAL] F
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And I'm checking now if they do any procedures or treatments in the doctor's office, that would be covered.
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] Oh, for the insurance, of course I do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I need to check one other thing I need to check with customer service. Do you mind? Well, hang on just a second, let me check one other thing.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Just trying to make sure.
[AGENT][NEUTRAL] Let me check this one.
[AGENT][NEUTRAL] That that isn't that the office visit is included. I don't wanna give you any misinformation.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just check.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, yes, for a specialist office visit, we can pay up to $50 for the co-pay.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, because their co-pay was 60.
[AGENT][NEUTRAL] And that is
[AGENT][NEUTRAL] Yeah, so we could pay up to 50 and that is 4 visits per calendar year.
[CUSTOMER][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That that is payable.
[CUSTOMER][NEUTRAL] But that doesn't show if I have any other ones, right? I don't think I.
[AGENT][NEUTRAL] I'm checking which.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Depending is this for?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let's see if she's maxed that maxed that out or if she still has any remaining.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah it looks like we've only paid.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so I'm calling.
[AGENT][NEUTRAL] One of those visits for [PII], so she should be eligible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you are, are you at the doctor's office?
[CUSTOMER][NEUTRAL] So how do
[CUSTOMER][NEUTRAL] I am here and I just did the co-payment for $60 yeah.
[AGENT][NEUTRAL] You did it?
[AGENT][NEUTRAL] Because I was just fixing to say they can file a claim for you and we can, and then if there's any reimbursement amount they would be um responsible for returning that to you.
[CUSTOMER][NEUTRAL] I have to go.
[CUSTOMER][NEUTRAL] OK, but how would I do that?
[AGENT][NEUTRAL] But it, it
[AGENT][NEUTRAL] So they can file the claim for you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But you said you've already paid it, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I already paid.
[AGENT][NEUTRAL] Can they cancel that transaction maybe?
[CUSTOMER][NEUTRAL] I don't know, let me ask.
[AGENT][NEUTRAL] I don't know. I'm just checking. OK, if not, then you can just file a claim for reimbursement.
[CUSTOMER][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] I think I could just do it myself then.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Who?
[AGENT][NEUTRAL] That'll probably be easier since you've already paid it so when you leave that office.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We're gonna need, there's several documents that we need for reimbursement. We're gonna need an itemized bill with diagnosis codes.
[CUSTOMER][NEUTRAL] The diagnosis code.
[AGENT][NEUTRAL] So they're gonna need to
[AGENT][NEUTRAL] Mhm. And then once.
[CUSTOMER][NEGATIVE] OK, let me see what they gave me. They gave me, they gave me something that says amount, the payment side, payment ID, the card number, the card brand, and then authorization code, and then it says card entry mode manual, but it doesn't tell me anything.
[AGENT][NEUTRAL] So that is just gonna be your receipt.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we're gonna need the itemized bill from them with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Just making sure I'm emailing you the correct card, bless you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And um then once your primary insurance processes that claim, we'll need the explanation of benefits. Who's your primary insurance with?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, Aetna.
[AGENT][NEUTRAL] Aetna, so once Edna processes the claim, then you'll.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Get that, um,
[AGENT][NEUTRAL] EOB or explanation of benefits from Aetna show what they applied to your deductible. We don't necessarily need the receipt.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Because we're gonna pay that benefit regardless of what you paid, we'll pay the benefit amount.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[AGENT][NEUTRAL] And have you created a login and password on our portal?
[CUSTOMER][NEUTRAL] I am not sure, to be honest.
[AGENT][NEUTRAL] Well, let me check that for you real quick too because if you haven't, you can always upload the claim form that's needed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Man.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] Let's see if you've uh created that account.
[CUSTOMER][NEUTRAL] I said yes.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah it looks like you have an account it's and the password is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]. Yep, you got it. You can also print additional cards from there as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Awesome, perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And I'm fixing to email you a copy of that card and if you ever have problems like that again, just ask them to call us and we can verify that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I, I told her, but she was like, oh, it's it gonna take forever to, to, to verify and so you have to pay the $60.
[AGENT][NEGATIVE] No, it does not.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] It's OK. It's OK.
[AGENT][NEUTRAL] You still have that, did it take you long for us to answer?
[CUSTOMER][NEGATIVE] No, at all.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Anyway, we, whatever. She just didn't wanna do it, but that's fine.
[CUSTOMER][POSITIVE] But I appreciate you. Yeah, I appreciate you anyways.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you. And if, once you have that EOB from
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] Your primary insurance, if you need help again, you know, know what to submit, just give us a call we'll be happy to assist you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Awesome. Perfect. Thank you so much and happy New Year's.
[AGENT][POSITIVE] I hope you have a happy New Year as well and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you.