AccountId: 011433970860
ContactId: bb0fb238-0e07-45c4-88a4-03fe2a144927
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526330 ms
Total Talk Time (AGENT): 157373 ms
Total Talk Time (CUSTOMER): 288017 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/bb0fb238-0e07-45c4-88a4-03fe2a144927_20250610T14:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. Um, the reason why I'm calling is I, my husband has gap insurance for himself and our daughters. Uh, we have received a bill from the pediatrician that we would like to submit, um, to for as to the gap insurance. We've never done it before, so we're trying to see how we can use this gap insurance and if we can.
[CUSTOMER][NEUTRAL] Use it to submit, you know.
[CUSTOMER][NEUTRAL] What's owed to the pediatrician, um,
[CUSTOMER][NEUTRAL] Could you help us, uh, help me out with that?
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, um, it's so I see here it says I have a group number and I have in-hospital benefits cert number and outpatient benefit cert number. Is that what you need? The certification number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, so I assume it's out of patients, out, out of hospital, so it's 02.
[CUSTOMER][NEUTRAL] 503-287 M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] OK. And uh what was the name on the policy?
[CUSTOMER][NEUTRAL] And yeah.
[AGENT][NEUTRAL] Do you have his date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And then what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then lastly, can you just verify the address on the account?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so what you'll need to submit a claim is the primary explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] And then we'll also need
[CUSTOMER][NEUTRAL] Um, like a, a bill.
[AGENT][NEUTRAL] No, so who is your primary, sir?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Um, the primary is, is through him like the primary insurance, you mean?
[AGENT][NEUTRAL] Yeah, like United Healthcare, Blue Cross Blue Shield, or Florida Blue, or
[CUSTOMER][NEUTRAL] A Aetna.
[AGENT][NEUTRAL] Aetna.
[CUSTOMER][NEUTRAL] [PII], mhm.
[AGENT][NEUTRAL] Aetna, OK.
[AGENT][NEUTRAL] Um, Aetna, so you'll need the pro you'll need the explanation of benefits showing how they process the claim.
[AGENT][NEUTRAL] So it has to go through them first.
[AGENT][NEUTRAL] Has to be submitted to them first by the pediatrician's office. Do you know if they've done that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And then whatever's left over, and are these just for office visits or?
[CUSTOMER][NEUTRAL] I know that's
[AGENT][NEUTRAL] Just offices it's OK.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] So let me, let, let me, sorry, I walked away from my desk. Let me get, I have a bill here that um that has already gone through the insurance.
[CUSTOMER][NEUTRAL] Give me one second so that I can.
[CUSTOMER][NEUTRAL] Well, I think it might be.
[CUSTOMER][NEUTRAL] My ears.
[CUSTOMER][NEUTRAL] Requesting.
[CUSTOMER][NEUTRAL] Sorry, I'm at work but I'm trying to do this at the same time. OK. OK.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Um, so yes, this uh,
[CUSTOMER][NEUTRAL] Let me see. Yeah, so this document here has um a bunch of data services and then on this document you'll also see where when Aetna made a payment or Aetna made an adjustment and then payments and adjustments and so on and so forth and um.
[CUSTOMER][NEUTRAL] How it is that they've gotten to the total.
[CUSTOMER][NEUTRAL] Um, and it shows you like what the doctor is charging for and what they decide to pay for.
[CUSTOMER][NEUTRAL] I does this, is this, does this sound like what you're requesting?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we'll, we'll need the actual primary explanation of benefits like do you have access to log on to Aetna site and print off?
[CUSTOMER][NEUTRAL] He, he does. Um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's just something he needs to print out from there?
[AGENT][NEUTRAL] Yeah, so if you log on, if he logs on to Aetna's site, there should be these dates of service on there. So that's the first piece that we'll need is the primary explanation of benefits and then does the document you have, does it have diagnosis codes and then show what was like what type of service they were seen for like office visit or?
[CUSTOMER][NEUTRAL] I'm not.
[CUSTOMER][NEUTRAL] Mm, I just, it does not have a diagnosis code. It just says like office visit, established patient level 3.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, the, we do need the diagnosis code. So, um, do you have like a, is there a portal you can log in for the, the doctor's office?
[AGENT][NEUTRAL] Sometimes it's located on there, like if you log into their portal, um, there'll be like office notes or something to that effect that'll show the diagnosis.
[CUSTOMER][NEUTRAL] OK, so I will.
[CUSTOMER][NEUTRAL] Get that for you. OK, so so far he needs to log into A and uh get the explanation of benefits, so.
[CUSTOMER][NEUTRAL] I have to explain this to him since I'm trying to like just make it baby steps for him. Um,
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Once he's into the port once he's in the portal for A Aetna, then he has to go to each service date, correct? And then in there, get the print out, basically print out each service date. So if um we're doing [PII], you have to go into that service date and print that out and then so on and so forth for every day that there's a bill.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Um, and the next thing was
[CUSTOMER][NEUTRAL] Do you possibly the Aetna would have the, since they were, they would have the medical, the diagnosis codes in there possibly since they were submitted to them for payment possibly, or they don't typically do that?
[AGENT][NEUTRAL] So they'll
[AGENT][NEUTRAL] Yeah, they won't typically like share the claim, um.
[AGENT][NEUTRAL] It's not usually on the explanation of benefits, so you're better off getting it from the provider's office. Um, you can, you can ask Aetna, you can certainly do that, um, but most of the time they're not gonna release that so.
[CUSTOMER][NEUTRAL] OK, so provider portal for diagnosis code.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And after that?
[AGENT][NEUTRAL] Um, after that, you can mail, fax, or he can create an online account.
[AGENT][NEUTRAL] And upload them
[CUSTOMER][NEGATIVE] So I tried, I tried to create the online account and it uh it gave me an error. um.
[CUSTOMER][NEGATIVE] I don't think he has an account already created. I put, I tried with the Social Security number and it said it's not a policy number. Then I put the number that I had given you and it says it's not a policy number, so I don't know what this wants from me.
[AGENT][NEUTRAL] Um, so he doesn't have an email address on file, and so he'll need to call in and update his email address.
[AGENT][NEUTRAL] Once that piece is completed, that's that's what's missing. We don't have an email address on file.
[AGENT][NEUTRAL] But he has
[CUSTOMER][NEUTRAL] OK, can I give that information? No, it has to be him.
[AGENT][NEUTRAL] No, it has to be from him.
[CUSTOMER][NEUTRAL] OK, perfect. And um is it to any number or is it a phone number?
[CUSTOMER][NEUTRAL] That um it's telling customer service that um this phone number option 4 that's what he has to do.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] OK, perfect. Alrighty, thank you so much have yourself a great day.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good day too.