AccountId: 011433970860
ContactId: f345798a-2061-4896-8521-bd5394d302e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631739 ms
Total Talk Time (AGENT): 353815 ms
Total Talk Time (CUSTOMER): 300192 ms
Interruptions: 5
Overall Sentiment: AGENT=1.7, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/f345798a-2061-4896-8521-bd5394d302e3_20250109T16:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I am calling from Cook Children's Physicians Network in [PII], um, about a claim, uh, just to, it's denied. I guess I need to validate what type of coverage this is. The card says it's not a major medical plan, so I just wanted to see what they, what coverage they have for.
[CUSTOMER][NEUTRAL] Benefits
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII].
[AGENT][POSITIVE] Thank you, [PII], and a good call back number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] My direct line is area code [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And do you have the claim number or the policy number for the patient?
[CUSTOMER][NEUTRAL] Let's see, I have policy number 01749315.
[CUSTOMER][NEUTRAL] And I probably have a claim number too if I get back over here.
[AGENT][NEUTRAL] Take your time. And I just need the patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] It's gonna be for [PII]. His date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service?
[CUSTOMER][NEUTRAL] This was on [PII].
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] $415.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][POSITIVE] All right, thank you. Me too. Excuse me too.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's that time of year.
[CUSTOMER][NEUTRAL] It really is. And mine's like a mixture. It's not a cold or anything, but it's the, the allergies and then the change in the weather. I'm in, in [PII], so we have the uh that winter storm falling right now. It's all that snow and everything.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's just this a little, just a little sniffle. I don't know.
[AGENT][NEUTRAL] It's just change of seasons. I think it, well.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] And I hope y'all stay safe in that winter storm. I hope you don't have to go anywhere.
[CUSTOMER][POSITIVE] I do not. I'm so thankful that we work from home still and it's just, yeah, it's a blessing.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Isn't it the greatest thing ever? I love it.
[CUSTOMER][NEUTRAL] It is, it is.
[CUSTOMER][POSITIVE] My dog loves it too.
[AGENT][NEUTRAL] I hear you. I know my dog is like, you're always home now.
[CUSTOMER][NEUTRAL] Anytime Ili she's like, where are you going? Can I go with you?
[AGENT][NEUTRAL] Exactly. So why are you going? Wait a minute.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] You're supposed to be home all day long.
[CUSTOMER][POSITIVE] Yeah, like any time you go out that door, I get to go out with you.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] I bet, I bet the dog don't wanna go out right now.
[CUSTOMER][NEUTRAL] Oh no, she's gone to the window a couple of times, looked out and did her little.
[AGENT][NEUTRAL] And like, mm mm, not today.
[CUSTOMER][POSITIVE] So, yeah, she's good. She's all cuddled up. She's
[AGENT][NEUTRAL] Oh, what kind of dog do you have?
[CUSTOMER][NEUTRAL] He is an Australian shepherd pit mix.
[AGENT][POSITIVE] Oh, I bet she's beautiful.
[CUSTOMER][POSITIVE] And so she is, she's so soft and she's so smart. That's what I love about her the most. She's so smart.
[AGENT][NEUTRAL] Oh, I did so.
[CUSTOMER][POSITIVE] She really is. That's a blessing. She was so, she was, she'll be 3 here in a couple of weeks, so yeah.
[AGENT][NEUTRAL] Wow. That she's out of her puppy stage, into her teen stage. She's a teenager.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] And she, she has her moments where I'm like, if you were a, a, a young little girl, I would probably lock you away right now.
[AGENT][POSITIVE] That's right. I, I love kennels. I never had a dog, I mean, used a kennel before with a dog, but with this, I have a 90 pound American bulldog. She's got some pit in her too. She's the tall, skinny.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Uh, bulldogs and strong, and so we started out with her in a kennel and she is, I love it. It, I always thought they were mean to put them in a kennel, but mm mm. She loves it. I love it, gives her a break. And she's getting crazy. I just thought, kennel, and she'll go lay down and calm down. Oh, it's the best thing. Anyway.
[CUSTOMER][NEGATIVE] Gotcha. Gotcha. Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And we, mine's the same way, you know, we trained her um because when we first got her, um, I was going into the office and stuff every once in a while. And so we trained her, you know, to stay in there that first year, you know, when I'd be gone, so she wouldn't get anything.
[CUSTOMER][POSITIVE] And now it sits there and when the doors just open and she'll go in there if she wants to and if she, like you said, if she gets a little rowdy, I'll say go to your crate and she'll get in there and just we don't have to shut the door or nothing. It's just, it's just an open door area for her. It's uh it's wonderful because I know other people who put them just keep them locked up, yeah, like I'm, I'm not locking her up. If she wants to go in there, she'll go if she doesn't, she won't.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't either.
[AGENT][POSITIVE] I think it's a safe place too.
[AGENT][NEGATIVE] Oh, I couldn't do that. I can't just give.
[AGENT][POSITIVE] That's right. Keep it her happy place. That way, when you need it, she's still happy, not, oh, I love dogs. Anyway.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I do too. I do too. No, you're good. I, I'm with you there.
[AGENT][NEGATIVE] I always said every time I, you know, I lose a dog, I think I'm not gonna do it again and I just can't not be without a dog, you know.
[CUSTOMER][POSITIVE] Yeah, she's the first one I've had and oh gosh, um.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] 15 years probably the last one that I had I lost her to cancer so yeah, it took me a long time before I got another one and I got a picture of her. She was a rescue and I was like, oh my gosh, and my cousin was getting her sister and she's like this one is still available and I'm like, Are you kidding me right now? Like, how can you send me that picture? That's not fair. And I went and got her. I was like, that's it is that you can. And even my husband was like, OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] How can you say no?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] He's like, yes, yes, we can have her. I'm like, OK.
[AGENT][NEUTRAL] Yeah. So I, I just gotta share this super quick with you. My last dog, um, passed on [PII], like 3 years ago.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And we went, it was a couple of weeks. Oh my gosh, she was, she was like the perfect dog ever, you know, just, just, just one of those dogs.
[CUSTOMER][NEUTRAL] It's tough to lose them, I know.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so I said, OK, uh, you know, I, I had my little grieving period.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] And I was like, I just don't know if I can go through that again. Well, my daughter lives with me, she's paying off her student loans, so we help each other. And um we decided, you know, I just, I just needed another dog. We went to the rescue center, and this dog, actually, I, I was going for a smaller dog, you know, one that I could bathe in the bathtub and all that good stuff.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And this dog just kind of chose us and we got her and then we started looking at the adoption papers. She was born on the same day that my last dog passed and I just thought.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That was a gift from God or you know, from.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Our last dog's name was Chica, so we figured that was the dog that [PII] picked out for us.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][POSITIVE] That's like the what is the the dog movies where um it's got Dennis Quaid where the dog goes from 5 different breeds. I believe that I really.
[AGENT][NEUTRAL] Yes, from.
[AGENT][NEUTRAL] Uh-huh. I do too.
[AGENT][POSITIVE] I do too because this dog has got a lot of the same characteristics of my last dog, even a completely different breed, completely different build, but she's got some of the same, you know, when she looks at you, it's almost like I can see my last dog in her.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I'm like, I believe that. I really do.
[AGENT][NEUTRAL] Yeah, but anyway, OK.
[AGENT][NEUTRAL] Let me, let me get you this claim information. Oh, no, it was a pleasure to talk to you regarding that. So make my day. Well, [PII], we did receive that claim on [PII] and processed on [PII], and this policy for [PII] is a secondary policy to the policyholders' major medical.
[CUSTOMER][POSITIVE] Ready when you are.
[CUSTOMER][POSITIVE] You too, yes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the claim is actually not denied it is pending for the primary EOB.
[AGENT][NEUTRAL] And we have on record that Aetna is their primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So once we receive that EOB from Aetna, we can continue processing the claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so it looks like it applied to their, their deductible. Um, can I send you the EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You certainly can. It can actually be faxed directly to our claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh wonderful. OK, what's that fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you just wanna fax it referencing that claim number, we don't need the HIA again we've already got that on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, the claim number that I had to see if I have the right one, I have 354 um 3211, is that the right claim number that I have? OK, perfect, so I will get that faxed right over to you.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And that should take care of that baby. OK. Um, is there a call reference? Oh, go ahead.
[AGENT][NEUTRAL] And we actually have.
[AGENT][NEUTRAL] I'm sorry, I didn't mean to interrupt you.
[CUSTOMER][POSITIVE] That's OK, no worries.
[AGENT][NEUTRAL] Oh we actually have a provider portal if you want to create an account online, you can just upload the EOB directly on the policy.
[CUSTOMER][POSITIVE] Oh, OK, I, I saw that on the card, the website. OK, I can do that too, perfect.
[AGENT][NEUTRAL] And to create an account you're just gonna use your tax number and the patient's account number listed in box 26 on the info.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When it ask for the patient account number, that's the one with your facility. It's the [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The peanut.
[CUSTOMER][NEUTRAL] Perfect. OK, alrighty well I will do that then and then I guess that's it um is there a call reference number?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII].
[AGENT][NEUTRAL] Reference number is my name, date, date.
[CUSTOMER][NEUTRAL] L as in [PII].
[AGENT][POSITIVE] And [PII], it's been such a pleasure to help you and I hope you and that precious little baby of yours, y'all stay warm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We will do our very best and you take care of your little baby too and I thank you so much for your help.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Yes, you too. Thank you. Mm bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.