AccountId: 011433970860
ContactId: d6b542f1-4cfb-4942-8220-2e3c2710baf5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507070 ms
Total Talk Time (AGENT): 196605 ms
Total Talk Time (CUSTOMER): 221673 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/d6b542f1-4cfb-4942-8220-2e3c2710baf5_20250402T16:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. Last initial [PII] I'm calling from Aetna member services.
[CUSTOMER][NEUTRAL] Um, I also have.
[CUSTOMER][NEUTRAL] Excuse me, my member and a mutual member of you guys as well, Ms. [PII] on the line, um, and she's just needing some help to know if a claim has been processed to you guys as secondary.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, it would be my pleasure to assist her, um.
[AGENT][NEUTRAL] What is a good callback number, [PII] in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, I don't have a specific callback number, but Ms. [PII] does. Um, I have [PII]. That's my husband. No, no, because he will not know what to do.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. Thank you, Ms. [PII], and it would be my pleasure to assist you. Do you happen to have your APL policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, um, well, OK, so there's a group number on the card, is that what you need?
[AGENT][NEUTRAL] At the bottom of the card, do you see the outpatient benefit cert number for hospital outpatient hospital certificate number? That's it.
[CUSTOMER][NEUTRAL] There's no nothing that says.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 0250180
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4 and then M like Mary, L like Larry, 8.
[AGENT][POSITIVE] Perfect. And do you mind
[CUSTOMER][NEUTRAL] And it is under my husband's the primary.
[AGENT][NEUTRAL] OK, thank you. And do you, not a problem at all. Do you mind verifying your um
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Uh, mine is [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] All right, thank you. And Miss [PII], is this claim for yourself, or [PII] or [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can check that claim for you. Do you happen to have a date of service?
[CUSTOMER][NEUTRAL] Yes, it's [PII] of this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the facility name? Do you have the provider's name?
[CUSTOMER][NEUTRAL] Um, it's Nicholas Children. It's their their urgent care, and I do see that this specifies, I guess it was a doctor.
[CUSTOMER][NEUTRAL] Id [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, we did receive the claim from Nicholas Children's Pediatrics for an office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's, let me see if I can pull that up because it doesn't show that it was for an urgent care, so let me just check on that claim document.
[CUSTOMER][NEUTRAL] An office business.
[CUSTOMER][NEUTRAL] Yeah, no, cause I, I haven't.
[AGENT][NEUTRAL] And it was for
[CUSTOMER][NEUTRAL] Taking her to no office visits only.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was for.
[CUSTOMER][NEUTRAL] It's her actual PCP, sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get this document up and let's take a look real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, Ms. [PII], I'm sorry to interrupt. Did you still want me to stay on the line, or did you wanna just continue with them since they did receive the claim?
[CUSTOMER][NEUTRAL] No, that's fine. I mean, yeah, you said that you guys have paid your end so.
[AGENT][POSITIVE] Yeah, I'll be happy to to help you with our portion of the claim.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, Ms. [PII], well, I'll go ahead and disconnect the call. Um, if you have any more questions, just give us a call back at the number on the back of your ID card, and you both you ladies enjoy the rest of your day.
[AGENT][POSITIVE] You too, [PII]. Thank you so much. Thank you.
[CUSTOMER][POSITIVE] OK thank you thank you no problem bye bye.
[AGENT][NEUTRAL] Alright, do you mind holding just one quick moment? let me get you to our claims adjusters to review this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would that be all right, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't need, I'm honestly, I'm looking, I just googled.
[CUSTOMER][NEUTRAL] This person's name. I, I'm not kidding because I don't, I didn't recognize his name at all. So I just Googled this person's name and yes apparently he works for Nicholas Children, but I never saw this human whatsoever and I've never taken my daughter to know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Really?
[AGENT][NEUTRAL] OK. Well, let me.
[CUSTOMER][NEUTRAL] I'll tell you right now, I never saw this man.
[AGENT][NEUTRAL] Yeah, so it does look like it was to the Miami Lakes Outpatient Center. It looks like that the doctor is charged and, yeah, but let me transfer you to a, a claims specialist to review this claim real quick, OK? And see if it can be processed under the urgent care benefit. If you don't mind.
[CUSTOMER][POSITIVE] Correct, which that makes sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, no, not a problem.
[AGENT][NEUTRAL] All right. Thank you, Ms. [PII]. One moment, please. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Oh, I'm good how are you?
[AGENT][POSITIVE] I'm doing good. Thank you for asking. Miss got back from her cruise.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Ready to go on another one, aren't you?
[CUSTOMER][NEUTRAL] I am, I am.
[AGENT][NEUTRAL] I have an insured on the line regarding a claim we paid the copay, but she's stating that it is for an urgent care. Can you review that claim with her?
[CUSTOMER][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] It's 250-1804.
[AGENT][NEUTRAL] And it's on participant 3, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have [PII] on the line. She's the spouse or the mom.
[CUSTOMER][NEUTRAL] And what uh what's that claim number or the data service?
[AGENT][NEUTRAL] The claim number is 357-070-6.
[AGENT][NEUTRAL] It's the only claim we have on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you. Give me one second to pull it right up.
[AGENT][POSITIVE] I appreciate it.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] It's got a place of service 20 on there.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We had just reprocess it but you can send it on send her on over.
[AGENT][NEUTRAL] All right. Well, if you'll hold just one moment, let me get this, you want her callback number just in case.
[CUSTOMER][NEUTRAL] Uh, yes, go ahead and give it to me.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, if you'll hold just one moment. Thank you. Have a good day.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] Ms. [PII], thank you for your patience. I have [PII] in our claims department. She's reviewing that claim and we'll assist you further, and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. OK. So,
[CUSTOMER][NEUTRAL] I received a bill right from [PII] for $25.
[CUSTOMER][NEGATIVE] And I know that they have on file both my primary insurance and you guys as my secondary, so I thought it was strange that I received this bill because I don't ever receive a bill.