AccountId: 011433970860
ContactId: b7f69c7a-eea5-41dc-ab91-62648eea4ac6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 632119 ms
Total Talk Time (AGENT): 221511 ms
Total Talk Time (CUSTOMER): 294845 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/b7f69c7a-eea5-41dc-ab91-62648eea4ac6_20250326T18:50_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? My name is [PII]. I'm calling because um I have uh my insurance that I also have the gap insurance, and I am pregnant, so I went to my OB and
[CUSTOMER][NEGATIVE] I signed the OB agreement, but uh now when I, cause for some reason they don't wanna call the the the gap insurance and um bill it directly through you guys so I made a a payment plan. I paid the first part and now when I submit my claim, it says that I need the fully itemized bill, but they say that they don't give me that until the end.
[CUSTOMER][NEUTRAL] Of my pregnancy. How, how, how can we go about that? Because it's $2100 something dollars and
[CUSTOMER][NEGATIVE] And I don't, I don't, I don't foresee that, you know, I'm paying $400.05 payments and, and I need that money back.
[AGENT][NEUTRAL] OK. Um, yes, ma'am. I can assist you. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] 532
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] OK, where do I see that in my insurance card? I have a payer ID and I have a group number. Is that what you need?
[AGENT][NEUTRAL] Do you see the outpatient certificate number?
[CUSTOMER][NEUTRAL] OK, yes, I do see that. It's 024.
[CUSTOMER][NEUTRAL] 518.
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify your first and last name again and your date of birth.
[CUSTOMER][NEUTRAL] [PII], first name, last name [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] OK. Now, please verify, let's see your mailing address and your email address.
[CUSTOMER][NEUTRAL] Mailing address. I recently moved, but it should be [PII]. That's my prior address.
[AGENT][NEUTRAL] OK, yes, ma'am. That's the one on file. And please verify your email address.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] F D G Felix.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And if you would like to um have your mailing address updated when we're done, I can transfer you to customer service and they can update your mailing address.
[CUSTOMER][POSITIVE] Thank you, I would appreciate that.
[AGENT][NEUTRAL] OK, no problem. And yes, ma'am, um, the information we need um in order to file the claim is not the receipts. We actually need the EOB from your primary insurance company. So once the provider files the claim with your primary insurance company and you get the explanation back for the date of service um that you wanna file the claim for, you'll send that information from us. We'll need your um primary explanation.
[AGENT][NEUTRAL] And benefits for the date of service. And we'll also need your diagnosis code. The diagnosis code is not on the explanation of benefits. So what you can do is reach out to your provider's office and let them know that you'll, you'll need documentation with your diagnosis code on it. And you'll send us that documentation um with your diagnosis code along with the EOB from your primary insurance company. And that's all the information we'll need for you to file the claim.
[CUSTOMER][NEGATIVE] Got it, but they're telling me that they won't give me that until
[CUSTOMER][NEUTRAL] I am done with my pregnancy, which is pretty much in October.
[AGENT][NEUTRAL] Well, um, that's not the
[CUSTOMER][NEUTRAL] But I need, I still need to do the payment.
[AGENT][NEUTRAL] Right. Um, it, it, it's not the.
[CUSTOMER][NEUTRAL] Cause it's some global thing.
[AGENT][NEUTRAL] Right. It's not the statement that we're asking for. We're just asking for documentation with your diagnosis code on there. You said that it's for your pregnancy and unfortunately, we can't take that information over the phone. We have to have it in writing from your provider's office. So if
[AGENT][NEUTRAL] They give you a letter or if they give you some type of documentation from the provider's office with your diagnosis code on it, you'll send us that information along with the explanation of benefits from your primary insurance company. So it's not a statement, it's just documentation um showing what your diagnosis code is.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Got it. OK, so what you need is not the OB plan. What you need is my diagnosis pretty much.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[CUSTOMER][NEUTRAL] With the code and then the explanation, OK, is there any chance that you can send me that in an email?
[AGENT][NEUTRAL] Um, actually, we're unable to send that information because of the HIPAA. We can't send that through email. No, ma'am.
[CUSTOMER][NEUTRAL] No, I was, I was saying like what I need on an email so I can tell her the, the, the office, the provider what exactly I need because.
[CUSTOMER][NEUTRAL] I don't know, I don't know if they're giving me the runaround or they don't wanna build the, the, the, the gap insurance directly and
[CUSTOMER][NEUTRAL] And I'm here paying everything out of my own pocket, so let me write that down then.
[AGENT][NEUTRAL] Yes, and take as much time as you need and if you read it back, you need documentation.
[CUSTOMER][NEUTRAL] So, say that again.
[AGENT][NEUTRAL] Showing what your diagnosis code is.
[AGENT][NEUTRAL] Or what your diagnosis codes are cause there may be more than one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you need the explanation of benefits for that day.
[CUSTOMER][NEUTRAL] For, for my insurance?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, from your primary insurance company.
[CUSTOMER][NEUTRAL] OK and primary insurance, so that will be with [PII]. I can get that through [PII].
[AGENT][NEUTRAL] Yes ma'am, you can get it from Aetna for the data services that you're filing a claim for.
[CUSTOMER][NEUTRAL] So you can go to the.
[CUSTOMER][NEUTRAL] Ask her if you can go to the uh in the app and get the information from there because if that happens you can go to the app. Like if I go to INA right now and I see my explanation of benefits, can I download that that document from ANA.
[AGENT][NEUTRAL] Um, yes, ma'am, and print that information off and send it to us. Yes, we take it that way as well.
[CUSTOMER][NEUTRAL] Got it. OK, yes, because the less that I have to ask them the better because they complicate everything. So from then the only thing that I need is the documentation showing my diagnosis code.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] For one check. Let me go and check and ask her. Hold on. Let me go to my my end and ask her if it is that.
[CUSTOMER][NEUTRAL] OK, you, I can hear options. No, let me submit a claim, no explanation of benefits EOB is that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, they provided.
[CUSTOMER][NEUTRAL] OK, so for example, I have one here that said [PII] summary statement integrate Regional Laboratory pathology [PII]. [PII], uh emergency medicine service of Air Florida LLC is that information what you need?
[AGENT][NEUTRAL] Yes, ma'am. So is that the date of service that she's filing the claim for?
[CUSTOMER][NEUTRAL] Something that
[CUSTOMER][NEUTRAL] You summary you're gonna have it you're gonna find it over there. So if you can download that page you can submit it to them, yeah, but I don't think that uh the thing is that for what I'm understanding from them is that they're not gonna.
[CUSTOMER][NEUTRAL] Charge my insurance until I'm done.
[CUSTOMER][NEUTRAL] So I don't know if it'll show on my insurance.
[CUSTOMER][NEUTRAL] The claim from their office because you need that explanation of benefits to show the claim from their office, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I'm back on the same thing again.
[AGENT][NEUTRAL] So they're not gonna charge Aetna either until after the pregnancy?
[CUSTOMER][NEUTRAL] Because you see it shows.
[CUSTOMER][NEUTRAL] That's what they're telling me, cause it's some global, I don't know, thing that they're saying.
[AGENT][POSITIVE] Oh wow.
[AGENT][POSITIVE] Yeah, that's definitely a first.
[CUSTOMER][NEUTRAL] So that that's, that's weird.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me see what I can do and if anything I'm gonna have to switch to another provider because.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can be paying that amount of money.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] When I have insurance.
[CUSTOMER][NEUTRAL] Uh, no, that, that's everything for now. And if you can please transfer me to customer service for the address change.
[AGENT][NEUTRAL] Yes, ma'am, one moment please and thank you for calling APL one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Check.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in the claims department. Um, I have a member on the line. I just finished assisting her with claim filing instructions and her um mailing address needs to be updated. Can you assist her with that over the phone?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh yes ma'am, I can.
[AGENT][NEUTRAL] OK. Her policy number is 024.
[AGENT][NEUTRAL] 51825 for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And her callback number is
[CUSTOMER][NEUTRAL] OK. And her callback number?
[AGENT][NEUTRAL] Yes, the one in the system.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Here she is. Thank you.