AccountId: 011433970860
ContactId: a04c5e9a-427c-42ee-9d91-643a2a9d17fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351809 ms
Total Talk Time (AGENT): 186255 ms
Total Talk Time (CUSTOMER): 116965 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/a04c5e9a-427c-42ee-9d91-643a2a9d17fd_20250109T21:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I need to check on a claim for my husband that was submitted.
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim information. Do you have the policy number available?
[CUSTOMER][NEUTRAL] Yes, it's 02505681.
[AGENT][POSITIVE] Thank you and what is your name please ma'am?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you Miss [PII], and what is a good call back number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, [PII].
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's see, and what is your husband's date of birth and name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is his data, I mean, I'm sorry, his current billing mailing address and email?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII] and the email is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And I don't see um authorization form online. Is he there to give us verbal permission to speak with you?
[CUSTOMER][NEUTRAL] Yes, yes, one second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, how are you doing?
[AGENT][POSITIVE] I'm doing well, Mr. [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Good, good, good.
[AGENT][NEUTRAL] Good, can you give us permission to speak with your wife [PII] regarding your claim information?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, please. Yes.
[AGENT][POSITIVE] All right. Well, it would be my pleasure and thank you. You have a lovely day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I am checking on this.
[AGENT][NEUTRAL] Hang on
[CUSTOMER][NEUTRAL] I have the claim number if you need it.
[AGENT][NEUTRAL] What is the claim number that you have?
[CUSTOMER][NEUTRAL] It's 354-726-5.
[AGENT][NEUTRAL] And this is for data service, uh, [PII] for.
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, I'm checking on that for you.
[AGENT][NEUTRAL] It looks like there was a claim processed on the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm checking on it
[AGENT][NEUTRAL] And have you checked with your primary insurance? Was there a responsibility applied to the deductible or co-payment or co-insurance?
[CUSTOMER][NEUTRAL] Um, last I heard is there was a, a balance of 6000 something from the charge of 213,000, and then that $6000 was going to be submitted to American Public Life, um, for processing and that's as far as I got, and I got a notice yesterday or a statement saying that they are waiting for um.
[CUSTOMER][NEUTRAL] What is it announcement that for the uh reference receipt uh explanation of benefits and stuff like that.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] So that's what I'm doing is I'm pulling up this claim and taking a quick look because.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The explanation of benefits that
[AGENT][NEUTRAL] Kindle uh hospitals sent.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Does not show anything applied to your deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] So that is what that is about it's possible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, this is from Aetna. It's possible that they may still be processing the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, with Aetna?
[AGENT][NEUTRAL] Yes ma'am, so we're needing a true explanation of benefits from Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Showing what was applied to the deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] For this hospital claim.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, so I should then reach out to the hospital and see what they've submitted to end now.
[AGENT][NEUTRAL] That's right, or and they're gonna receive the same EOB that y'all received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] It'll have the same information and you know maybe they'll send in it and if you have access to Aetna's website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can check on that claim and see if they did in fact apply something to the deductible copay or coinsurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. OK, alright, I'll do that and see if anything's come through.
[AGENT][NEUTRAL] And then that
[AGENT][NEUTRAL] Yeah, and that can be submitted and I'm just checking one other thing I see you have an active online account or Mr. [PII] does.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if you happen to get an updated explanation of benefits from Aetna that does show for this hospital claim a deductible co-pay or co-insurance, you can actually upload it online and we can continue processing the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, I'll look into it and I'll look into that. OK, that's perfect.
[AGENT][POSITIVE] I know it's been a pleasure to assist you with that claim information, Ms. [PII]. Anything else I can help you with today?
[CUSTOMER][POSITIVE] That is it for today. Thank you so much. I appreciate it.
[AGENT][POSITIVE] It's been such a pleasure to assist you. Thank you for calling APL. I hope you all have a lovely evening. Stay warm wherever you are.
[CUSTOMER][POSITIVE] You too. You too. All right. Thank you. OK, bye-bye. Uh-huh.
[AGENT][POSITIVE] Thank you bye bye.