AccountId: 011433970860
ContactId: faa6cb6c-1560-4437-88ad-285c2c5351f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1269479 ms
Total Talk Time (AGENT): 489467 ms
Total Talk Time (CUSTOMER): 345985 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/faa6cb6c-1560-4437-88ad-285c2c5351f5_20250506T21:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes. Um, I had a question about a
[CUSTOMER][NEUTRAL] Excuse me, a claim that I filed, um, I wondered if you could check the status of that for me.
[AGENT][NEUTRAL] OK, um, what is your policy number?
[CUSTOMER][NEUTRAL] Um, is that what's on my card?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Let's see, it says inhospital benefit number. Would that be what you need?
[AGENT][POSITIVE] Yes, thank you. I'll take that.
[CUSTOMER][NEUTRAL] OK, 02406268.
[CUSTOMER][NEUTRAL] ML 7
[AGENT][POSITIVE] Thank you so much. May I have your name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you and your call back number if we are disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and verify your complete mailing address.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, we have a different mailing address on file.
[CUSTOMER][NEUTRAL] Would it be [PII]?
[AGENT][NEUTRAL] Can you verify that, please?
[CUSTOMER][NEUTRAL] Uh, it's from books.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is that um the number please?
[CUSTOMER][NEUTRAL] 01 13.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, give me one moment please um and what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Maybe if you would just give me your current mailing address again, please.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and if you could spell that for me please? [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And that was [PII] you stated? OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the zip code.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII]. OK, I'll put the request in and have your mailing address updated for you. OK, thank you for that verification process. You're welcome and you're calling to check on a claim, OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It shows we have a claim that was processed um back in April. It was an inpatient. You were admitted into the hospital. Is that the claim you're requesting information on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we are requesting the explanation of benefits from your primary insurance provider.
[CUSTOMER][NEUTRAL] Um, I'm pretty sure I sent that.
[CUSTOMER][NEUTRAL] I, I took a screenshot of it and.
[CUSTOMER][NEUTRAL] Uh, uploaded that.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] see what we have here.
[AGENT][NEUTRAL] Cost of America Care Center.
[AGENT][NEUTRAL] 224.
[AGENT][NEUTRAL] Let me go to the prior submission of it one moment.
[AGENT][NEUTRAL] And that date was [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, I think, are you talking about the stay in the hospital?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I believe it was till [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I was discharged on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you copy of that. That's the bill, the bill for. I'm just talking to myself. Give me one second please.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, so let's go back up here.
[AGENT][NEUTRAL] To builds see 140,000.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] Show and the second solution that was on.
[AGENT][NEUTRAL] 42425.
[AGENT][NEUTRAL] Can I place you on brief hold please, Ms. [PII]?
[CUSTOMER][NEUTRAL] Sure. Sure.
[AGENT][POSITIVE] OK, thank you, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 224.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you so much for your patience, Ms. [PII]. OK, what you uploaded, thank you. And what was uploaded on the last submission that we received from you, um, it shows an in-network spending claims. However, it does, you were in the hospital from [PII] [PII]. Is that when you're discharged?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII], OK, [PII].
[CUSTOMER][NEUTRAL] I believe
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We are requesting a more detailed explanation of benefits that has that date span on it.
[AGENT][NEUTRAL] What you submitted was, it was like a um just like you say a a like a snapshot of, but we need a more detailed um explanation of benefits.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] From the insurance company?
[AGENT][NEUTRAL] Yes, ma'am, from your insurance company, from your major medical insurance company.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. I think that's all, like, I looked up explanation of benefits, and that's all that's all that is available to me.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I went in under the app and hit explanation of benefits and that's what came up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I sent in the paperwork from the hospital that showed uh
[AGENT][NEUTRAL] You did send that in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes, you did send that in and thank you for that UBO4, um, now we just need that explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From your major medical. Yes, ma'am.
[CUSTOMER][NEUTRAL] Does it
[CUSTOMER][NEUTRAL] Does it show explanation of benefits? Does it show I
[AGENT][NEUTRAL] What you submitted
[CUSTOMER][NEUTRAL] Like that's all that is available.
[AGENT][NEUTRAL] What you submitted shows in-network spending claims current plan year um [PII]'s spending and network expanding but um what we're looking for is the explanation of benefits and it should be available on the website, your major medicals website.
[AGENT][NEUTRAL] 1518515.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yes, I'm not sure how to do that. I thought that's what I sent you. That's not what I sent you.
[AGENT][NEUTRAL] No, ma'am. No, ma'am.
[CUSTOMER][NEUTRAL] Explanation it didn't say explanation of benefits on it?
[AGENT][NEUTRAL] No, ma'am, it, it says in-network spending claims.
[AGENT][NEUTRAL] Current plan year, [PII] uh we spending.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it goes on.
[CUSTOMER][NEUTRAL] It didn't have the Casa Palmera.
[AGENT][NEUTRAL] It did have Casa Palmera Care Center LLC. It says visited on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you stated that you were out, you were discharged on the [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is your major medical Aetna? Is that still your major medical?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Cause it, it didn't have
[CUSTOMER][NEUTRAL] The dates, like the um discharge dates because they started paying before I left.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes ma'am, that and that we're requesting that that that is what we need before we can process the claim or finish processing the claim.
[CUSTOMER][NEUTRAL] So it has to have something with the beginning date and the end date.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It, am I understanding that?
[CUSTOMER][NEUTRAL] OK. And, and then upload it through the website?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes you can and when you do that, um, Miss [PII], if you're able to um maybe name the file, I can provide you with the claim number that way we'll know exactly where it needs to go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Here we go. All right. um, and the claim number?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] The claim number is the initial claim number is 3,593,730.
[CUSTOMER][NEUTRAL] 35, I'm sorry, 359.
[AGENT][NEUTRAL] 3730.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] 30 OK.
[AGENT][NEUTRAL] Now, we have a different date of service. I'm sorry.
[CUSTOMER][NEUTRAL] Uh, you know what, I
[CUSTOMER][NEUTRAL] Oh no, go ahead.
[AGENT][NEUTRAL] We have a different date of discharge for you. Um, let me just make sure what we have here.
[CUSTOMER][NEUTRAL] Well, I'm, maybe I was mistaken.
[AGENT][NEUTRAL] That's OK. We have you discharged on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let's see, discharge date of [PII] is what I have on my paperwork.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]. OK, I'm still looking at this. I don't know [PII]. That's [PII] there.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] [PII], OK, I see that now. OK, yes ma'am, I see that now. Thank you for that correction [PII] discharged discharged.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes ma'am, so that's what we need if you're able to get please um submit that with uh to us that explanation of benefits and let and just to make sure you have that claim number, it is 35 yes ma'am, 3,593,730.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and what should I, um, obviously, there was a point where you were waiting for me to send something in, but I was not aware of that. So how going forward, how can I know that
[CUSTOMER][NEUTRAL] Uh, you're waiting for me to, you know, nothing was sent to me saying, we're waiting on that. So I assumed you had all of the information you needed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there any way you notify me?
[AGENT][NEUTRAL] Uh, well, you are able to check claim status on the online service center. However, we have your old address.
[AGENT][NEUTRAL] On file, so and the claim was processed on [PII], so that may be why you did not receive the explanation of benefits, but you're able to check claim status on the on the website.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK. And just, I have called and changed my address. So um I did take care of that, but it sounds like it didn't get through to the right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, to the right place to get my address changed, so, so something was sent to the [PII] address.
[AGENT][NEUTRAL] OK. Now, let me just go back to, you said that your address was changed. Let's see here. I address has been changed.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], but it's [PII] now, correct. It was changed.
[CUSTOMER][NEUTRAL] Yes, and I, I changed that from the [PII] to [PII].
[AGENT][NEUTRAL] OK, I don't have that um in our notes, but I can change that for you, um, that can be changed, but yes ma'am, so it's possible that that ELB was mailed to the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Well, let me uh get an explanation of benefits that has
[CUSTOMER][NEUTRAL] I guess the dates on it. Do you have any explanations of benefits?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] If any, is it show that I sent in an explanation of benefits?
[AGENT][NEUTRAL] You sent OK, so [PII] so far it does show when you first initially sent in the claim on excuse me, [PII].
[AGENT][NEUTRAL] [PII]d. It does show.
[AGENT][NEUTRAL] [PII] statement explanation of benefits. And this is from service dates from [PII].
[AGENT][NEUTRAL] But not all the way
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, well, I will look that up and um.
[AGENT][NEUTRAL] And I was also going to, yes ma'am, thank you. And I was also going to add it does not show any deductible, co-pay or co-insurance. So, but yes ma'am, we'll need that date range, please.
[CUSTOMER][NEUTRAL] Get it over to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And now, what about the deductible? What, do, do you have to see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The receipts that I paid the deductible?
[AGENT][NEUTRAL] No, we will need to see that on the explanation of benefits from your primary from Aetna.
[AGENT][NEUTRAL] So that is what we're needing.
[CUSTOMER][NEUTRAL] OK, is there any way I can.
[CUSTOMER][NEUTRAL] Do it and then call back and make sure that's what that I'm submitting what you're requiring.
[AGENT][POSITIVE] You can give us a call back, yes.
[CUSTOMER][NEUTRAL] Like, does it show right away? OK. All right. I think I'll do that.
[AGENT][NEUTRAL] Does it show right away, um.
[AGENT][NEUTRAL] It in some cases it may show right away. It can take up to 24 to 48 hours, but you're more than welcome to give us a call once you've uploaded that documentation.
[AGENT][NEUTRAL] To check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, I'll do that then. Thank you very much for your help.
[AGENT][NEUTRAL] You're welcome. And let me just go over the the mailing address just to make sure. I have [PII].
[AGENT][NEUTRAL] [PII]. Oh my gosh, I'm sorry. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that's it.
[AGENT][NEUTRAL] OK, I will get that request to have that updated to that address.
[CUSTOMER][POSITIVE] Thank you. Thank you.
[AGENT][POSITIVE] You're welcome. You're welcome.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][POSITIVE] And OK, thanks for calling AP. I'll take care. Bye-bye.