AccountId: 011433970860
ContactId: c84a7b71-75e8-4ace-8a5c-9098eb8881e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243860 ms
Total Talk Time (AGENT): 56568 ms
Total Talk Time (CUSTOMER): 143929 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/c84a7b71-75e8-4ace-8a5c-9098eb8881e7_20250318T21:44_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], how are you doing? I'm, uh, [PII]. Uh maybe you need the policy number and I have a reference number. I guess they're the same.
[CUSTOMER][NEUTRAL] You ready?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK. 02464646.
[CUSTOMER][NEUTRAL] And I have the claim number also.
[AGENT][NEUTRAL] OK, and Mr. [PII], if you can please verify your date of birth and email address.
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII].
[AGENT][POSITIVE] Thank you for that and um.
[AGENT][NEUTRAL] You said you have a claim number?
[CUSTOMER][NEUTRAL] Yes, uh 357-383-1.
[AGENT][NEUTRAL] Is this for a dependent?
[CUSTOMER][NEUTRAL] Yes, for my son.
[AGENT][NEUTRAL] And what's the dependent's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that information and how can I assist with the claim?
[CUSTOMER][NEGATIVE] Yes, because I don't, I don't, I don't understand uh what they mean that I, uh, what I need to provide because I don't have that insurance any longer, uh, it was Aetna.
[CUSTOMER][NEGATIVE] And uh they sent me this is not a bill and they said uh let me read to you what it says.
[CUSTOMER][NEUTRAL] Uh, it says benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid. Um, I end up pay some, but then I, I, I use the gap.
[CUSTOMER][NEUTRAL] To, you know, for the deductible, but, uh, uh, like I told you, I changed insurance and that this was last year, so I don't understand if if you guys paid it or not.
[CUSTOMER][NEUTRAL] So I just wanted that's why I'm calling.
[AGENT][NEUTRAL] OK, we received a claim from Memorial Hospital Pembroke for that data service, um, but because there was no payment made by your major medical, we couldn't pay.
[AGENT][NEUTRAL] So we denied the claim.
[CUSTOMER][NEGATIVE] So you denied the claim because you would, uh, and that didn't pay for it.
[AGENT][NEUTRAL] Right. Aetna denied it because Aetna said that your
[AGENT][NEUTRAL] Let's see, on the explanation of benefits, it says that policy benefits have been exhausted.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] And this is OK um and uh.
[CUSTOMER][NEUTRAL] This, uh, then, I mean, this, uh, date, who was the, the, the, the person that [PII] was the one that that was in the hospital, it was, uh, it was me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It was a manual, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so then it, it, it, how would I go? I talk to and that.
[CUSTOMER][NEUTRAL] because I need to know what was the reference. I thought everything was paid. That's why I they send the claim to you guys.
[CUSTOMER][NEUTRAL] You know, so, and then I, I left.
[AGENT][NEGATIVE] No, Aetna didn't, Edna didn't pay anything and they didn't.
[CUSTOMER][NEUTRAL] Yeah, no, yeah, no, how would I go?
[CUSTOMER][NEGATIVE] I would go about finding out why and why they didn't tell me anything because, you know, I didn't get nothing from them. I, I, I just received this.
[AGENT][NEUTRAL] You will call [PII].
[CUSTOMER][NEGATIVE] I just received this right now because I'm not they never sent me anything [PII], I can't do.
[CUSTOMER][NEUTRAL] Alright, so then I need to call him now.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there anything else I can assist with today?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] No, that's it, thank you.
[AGENT][POSITIVE] Thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] OK