AccountId: 011433970860
ContactId: c65fb6aa-178e-4c7d-b75a-234ba489fc99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699719 ms
Total Talk Time (AGENT): 362915 ms
Total Talk Time (CUSTOMER): 321098 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/c65fb6aa-178e-4c7d-b75a-234ba489fc99_20250116T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling because I received um a
[CUSTOMER][NEUTRAL] Uh, thing in the mail about my son's claims, um, so I was just calling to check in on a couple of them.
[AGENT][NEUTRAL] OK, yeah, I can check those claims for you uh what was your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's 0165.
[CUSTOMER][NEUTRAL] 3654
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] OK, just gonna verify some information really quick. Uh, can I get your date of birth please, [PII]?
[CUSTOMER][NEUTRAL] Yep, it's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Yep, it's [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Yep, [PII].
[AGENT][NEUTRAL] Alright appreciate you verifying all that information. OK, and which dependent was this for?
[CUSTOMER][NEUTRAL] Um, so I have questions for both of my sons. One is [PII].
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, do you happen to have that claim number?
[CUSTOMER][POSITIVE] Um, that is a great question. Um, it's
[AGENT][NEUTRAL] If not, that's OK.
[CUSTOMER][NEUTRAL] Because it's not the one that I re yeah it's not the one I received in the mail, so there is a um.
[CUSTOMER][NEUTRAL] Date of service date for [PII] and [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I submitted a UB40 for both of those visits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I also submitted his EOBs, um, I submitted his EOBs today for those visits. I was wondering if there's anything else that I would need to provide because I've been receiving um for his other claims in the mail, I got that I needed to attach his EOBs.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Which I know the diagnosis codes are missing because I still they're they're mailing those to me but for this other claim it they do have the EOB in the system so I don't know why they're sending me a rejection with the EOBs on there as what I need to provide when they've already been provided is all so I'm just.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see. OK, OK, so I do see where we did receive some claim information um of course I'm not able to view it as it's still being processed, but I can see that we've received it so this other claim for [PII].
[AGENT][NEUTRAL] Let's see, got several different dates of service, so [PII].
[CUSTOMER][NEUTRAL] I think [PII], yeah, the [PII] ones is the one that I got the rejection letter for saying that they don't have EOBs for that. Um, I think it's [PII] is, I think one of the providers that wasn't covered by my insurance.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's not this one then, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] You, uh, so your
[CUSTOMER][NEUTRAL] But I guess, I guess I'm asking.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess what I'm asking is like why am I getting a reduction letter saying I need to attach his explanation of benefits for those visits when I did attach them.
[CUSTOMER][NEUTRAL] Like is there's something else I need to be doing? Like, am I attaching them wrong?
[AGENT][NEUTRAL] Give me just a minute let me see. So did you say, I'm sorry, just so I understand correctly, your primary, uh, did help pay for these procedures, is that correct?
[CUSTOMER][NEUTRAL] The circumcision I know isn't covered, but they did not, they did help, well, they didn't pay them. What they did was I got the discount for my primary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see. OK, yeah, circumcision not covered. One was a.
[CUSTOMER][NEUTRAL] Which I understand that, but there were other visits like the discharge visit and the other visits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, two of them are registering as.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Duplicate.
[AGENT][NEUTRAL] So I'm gonna look at those, give me just a moment. That was.
[AGENT][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, and then as for the others, there are two other items, um, and it is saying, of course, the primary EOB and the diagnosis codes. So if we, that's not necessarily, sometimes that's just kind of a group, um, I know it's a bit confusing, uh, response that's not necessarily saying that we didn't receive the EOB it could be that we're just missing those diagnosis codes, but we can verify that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK cool because those are.
[CUSTOMER][NEUTRAL] What I'm waiting in the mail for, so, because I guess they couldn't send to me, yeah, so.
[AGENT][POSITIVE] OK, perfect, yeah.
[AGENT][NEUTRAL] OK, and then let me check this where it says that these two are duplicates, bear with me just a moment.
[CUSTOMER][POSITIVE] Yeah, no, you're good, which honestly I've gotten so much paperwork, and I'm like, I'm just keep uploading stuff because between him and [PII], and the amount of times we've been to the ER for [PII], it's like I can't keep up with what I've, I've freaking uploaded and what I haven't, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I completely understand.
[AGENT][NEUTRAL] OK, so the two that were registered as.
[AGENT][NEUTRAL] Duplicates
[AGENT][NEUTRAL] That's what we received and made a claim for that was [PII] and all of those are stating that we're missing information either the primary EOB or the diagnosis codes so I imagine that's a bunch of other stuff that you had resubmitted with that corrected information.
[CUSTOMER][NEUTRAL] Yes, and I think also to the my issue is like the EOBs don't just have like [PII] on there, so probably like they have other stuff, so I think sometimes to like claims is thinking I'm submitting that for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The other stuff that was covered, but it's more so like pediatrics, which is not covered by my insurance, but I get a discount for, but they don't pay them is what I'm mostly.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, fun stuff over here.
[AGENT][POSITIVE] Oh I see OK yeah sounds like it gosh I'm so sorry. um I will say, and I'm sorry if this is repeated information maybe they don't accept it but if you were not aware you can going forward of course wherever you go or the children go for uh treatment you can try giving them this information, the providers and see if they'll will they not file for you OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh no, you're fine.
[CUSTOMER][NEUTRAL] I did. They
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEGATIVE] Well, the thing is they're like, oh, this is life insurance, and I'm like, no, it's not. No, this is.
[AGENT][NEUTRAL] No
[AGENT][POSITIVE] Well, in that case, they are more than welcome to give us a call. We do talk to providers all the time. All they would have to do is be able to verify, um, you know, the name and date of birth of the patient, and then we can explain the plan what all is and is not covered, um, any information that they need. So if going forward, I would say it's worth a shot to save you a headache, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know, I know. It's just a lot of times this, all of these visits have been in the hospital and it's like, I don't know who is covered by Aetna and who's not. And it's not until like I get a bill that I'm just like, OK, but I do give the hospital American public life, but like my last child, I made sure to do that like from the get-go, but they still, like these people who come in with billing, they're like ding dongs, and they're like, oh, is this like life insurance? I'm like, no, like uh.
[AGENT][POSITIVE] Oh gosh, yeah, yeah, you're right.
[AGENT][NEUTRAL] Who do I talk to? Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I have fought with you guys so many times. No, you dinglings, like, come on.
[AGENT][NEUTRAL] I know and unfortunately it does depend on each provider they're totally different. Some are like, oh yeah, we'll take care of that for you and others are just like what is that?
[CUSTOMER][NEUTRAL] I know, so I'm just like, mm, OK, um, but yes, so the dates of service for [PII] and [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I, I'm pretty sure I provided everything so that should be hopefully done.
[AGENT][NEUTRAL] Right, OK, so, and I do see the [PII]. I don't see anything for the [PII], but that might be what you submitted just today, um, so that's obviously still in line for processing, um, as for [PII], I do see the, um, sorry, go ahead.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Stop
[CUSTOMER][NEUTRAL] I'm so sorry. I thought I submitted an EB4 UB40 for the [PII] though.
[AGENT][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Ah, did you do that today?
[CUSTOMER][NEUTRAL] No, I did that, I think a couple of
[CUSTOMER][NEUTRAL] I think end of last week.
[AGENT][NEUTRAL] OK, so why don't we do this, [PII], um, I can, I did go ahead and look at for [PII]'s, um, we received [PII], and that was for date of service that was [PII] or no sorry [PII] and [PII] and [PII] OK of this year and this is stating, you know, pretty much the same, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] EOB primary EOB and diagnosis codes so what I think if it's OK with you unless you'd rather wait, um I can put you on a brief hold and reach out to our claims specialist and they can go through and review the information that was.
[AGENT][POSITIVE] Submitted just in case um and they can go over all of that with you if you know because we are human sometimes there's those little human errors like oh yeah you know kind of skipped that um or if yeah they they would be able to help you exactly what information we still need.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Did you want me to do that? OK, yeah.
[CUSTOMER][POSITIVE] That would be great because that would be fantastic so I can kind of like start dwindling this down and hopefully be done.
[AGENT][NEUTRAL] Kind of
[AGENT][NEUTRAL] Absolutely, yeah for sure OK so I'm just gonna put you on a brief hold while I get them on the line OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Thanks for calling ATL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm good, and yourself?
[AGENT][NEUTRAL] Doing all right, thank you. I've got an insured on the line, um, calling regarding a couple of claims for two dependents, um, stating that we're missing uh primary EOB and diagnosis codes. She believes she sent that information in with it and just kind of wants to review what was submitted and what else she needs.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Policy number is 01653654.
[AGENT][NEUTRAL] And these claims are for uh parts 2 and 3.
[CUSTOMER][NEUTRAL] And who's the member on the phone?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What claim is she calling about?
[AGENT][NEUTRAL] So for part two, the claim is 355-0524.
[AGENT][NEUTRAL] And then for part three it is uh 355-0569.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You can send her over and I'll be able to tell her while we've been make the payment on the client. You're welcome. Have a good one.
[AGENT][POSITIVE] All right, thank you, sounds good thank you you too.