AccountId: 011433970860
ContactId: 100be5fb-e79e-43c9-8be2-76bbc7718860
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259040 ms
Total Talk Time (AGENT): 110769 ms
Total Talk Time (CUSTOMER): 83644 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/100be5fb-e79e-43c9-8be2-76bbc7718860_20250408T14:31_UTC.wav
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[AGENT][NEUTRAL] For calling APM my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], uh, calling about my medical coverage, um.
[CUSTOMER][NEGATIVE] And I, I've got a procedure coming up, but it says it's out of network and it won't be covered under my insurance.
[AGENT][POSITIVE] OK, I'd be happy to assist with your benefits. May I have your policy number, please?
[CUSTOMER][NEUTRAL] Um, 0258.
[CUSTOMER][NEUTRAL] 1226.
[AGENT][NEUTRAL] And your first and last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And Mr. [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] And if you can verify your date of birth and your email address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Email is gonna be [PII].
[AGENT][NEUTRAL] OK, that's not the email we have um.
[AGENT][NEUTRAL] Do you want to
[AGENT][NEUTRAL] Put that one on there that you just gave me?
[CUSTOMER][NEUTRAL] OK, what about [PII]?
[AGENT][NEUTRAL] Yeah, that's what we have.
[CUSTOMER][NEUTRAL] OK, that's that's my work email.
[AGENT][NEUTRAL] Which email did you want on the account?
[CUSTOMER][POSITIVE] Uh, the work one is fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, thank you for that and please be advised the verification of coverage is not a guarantee of payment. Now, so you, what you're saying is your major medical has already said that they're not going to cover a particular.
[AGENT][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] When you say not covered, meaning not covered at all or meaning they applied it to your deductible and you got
[CUSTOMER][NEUTRAL] Yeah, they, uh.
[CUSTOMER][NEGATIVE] Um, they're not covering it at all. They say it's on the network.
[AGENT][NEUTRAL] Oh, OK, so we follow the guidelines of your primary. So if they deny the claim for not and and it's not covered, then it's nothing that we can pay because we only pay if they apply any.
[AGENT][NEUTRAL] To your deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, this is American Public Life. Should I call Summer care or who do I need to call about this?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh, uh, do you have another gap insurance or?
[AGENT][NEUTRAL] Or, or another major medical?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, now this is through my job, correct? through OME.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] I mean, I don't know who else you would call. I mean,
[AGENT][NEUTRAL] I mean, unless you have another major medical company.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK, then you would need to, then this is something that you would have to um who is your major medical company?
[CUSTOMER][NEUTRAL] Uh, summer care.
[AGENT][NEUTRAL] Summer care is your major? OK, so then you would need to speak with summer care.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] About why they're not covering it, but we can't, we can't override what summer care says.
[CUSTOMER][NEUTRAL] No, no, I mean I'm just.
[CUSTOMER][NEUTRAL] Alright, yeah, let me give them a call and see what's what here so.
[AGENT][NEUTRAL] I mean it may be something that we that you they said it's out of network well maybe they can provide you with some who well who's in network that can do what I need done? Do you have a list of in-network providers that I can go to so it can be covered?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, let me give them a call and see what they say.
[AGENT][NEUTRAL] OK, well, was there anything else I could assist with today?
[CUSTOMER][NEGATIVE] Oh man, unbelievable.
[CUSTOMER][POSITIVE] No, that's it thank you dear.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too.