AccountId: 011433970860
ContactId: 144db359-d72b-4f34-9be0-2e715f393c68
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534679 ms
Total Talk Time (AGENT): 148841 ms
Total Talk Time (CUSTOMER): 257483 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/144db359-d72b-4f34-9be0-2e715f393c68_20250227T17:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, uh, my name's [PII]. I had a, uh, question about the bill that was, uh, declined.
[AGENT][NEUTRAL] OK, uh, what is your policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Group number.
[CUSTOMER][NEUTRAL] Um, let me get that. Hold on, will policy number work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir, the policy number.
[CUSTOMER][NEUTRAL] OK, hold on a second, I thought I just saw here.
[CUSTOMER][NEUTRAL] Actually I don't, it's uh MAU 9437, the group number 9437.
[CUSTOMER][NEUTRAL] Let me get uh my card though.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 0235.
[CUSTOMER][NEUTRAL] 1096
[AGENT][NEUTRAL] OK, thank you. Let me one moment.
[AGENT][NEUTRAL] OK, and Mr. [PII], uh, verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII] [PII] [PII], uh [PII] or [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you show a different email address at iCloud?
[CUSTOMER][NEUTRAL] Uh, yeah, actually, um, yeah, that's, uh, that's a different one. That's the other one I use.
[AGENT][NEUTRAL] OK. Would you rather use the other one or leave this one?
[CUSTOMER][NEUTRAL] It's uh uh [PII].
[CUSTOMER][NEUTRAL] Let's use the other one [PII]. Yeah, let's use that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you say Ere.
[CUSTOMER][NEUTRAL] That the other one, the first one I gave you is the old one.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you, sir. And you said you had a question about a claim that was denied?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, do you happen to have that claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, data services uh 18.
[AGENT][NEUTRAL] Of this year
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] And the claim was for yourself.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't show a claim for 18. Do you have that claim number?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, I just got a, I got a bill from this dermatologist.
[CUSTOMER][NEUTRAL] And uh they're saying that.
[CUSTOMER][NEGATIVE] Uh, based on this, that, uh, yeah, insurance, none of the insurance was paid. I've got a bill sitting here for $1000.
[CUSTOMER][NEUTRAL] Over $1000.
[CUSTOMER][NEUTRAL] So all I have from you, you guys so far 90 degree benefits is a uh explanation of benefits.
[CUSTOMER][NEUTRAL] And then I have uh some coded things for denials. So basically, I came in uh to the dermatologist and had some, uh, they took some uh uh samples of the skin cancer and sent it off to the lab.
[CUSTOMER][NEUTRAL] And it came back as basal cell, you know, skin cancer. And I've been on the [PII], I had this removed. I had surgery to have it removed.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Does she have a surgery benefit, uh, but not any benefits for an office visit, um.
[AGENT][NEUTRAL] But you're not sure, you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] That was, yeah, the biopsies that were done performed on that, on, yeah, on the skin cancer, they were performed on the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I had surgery on [PII].
[AGENT][NEUTRAL] I see a claim for 210 and looks like we paid um 125 to the provider.
[CUSTOMER][NEUTRAL] 125.
[AGENT][NEUTRAL] Uh, yes, sir.
[AGENT][NEUTRAL] Um, that's the max benefit payable for surgery in a physician's office, um.
[CUSTOMER][NEUTRAL] OK, well, the bill.
[CUSTOMER][NEUTRAL] Sure, for skin cancer?
[AGENT][NEUTRAL] For any surgery performed.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] For any surgery, it's the maximum pay is what? 100 and what?
[AGENT][NEUTRAL] 125 if the surgery is performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm and you're saying you guys paid that.
[AGENT][NEUTRAL] Oh, yes, sir. We pay $125 to the provider for that 210 data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's crazy. OK, what about this pathology thing with the, uh, what was it, was anything paid there?
[CUSTOMER][NEUTRAL] Am I going to get a bill for that too?
[AGENT][NEUTRAL] Uh, that I'm not sure, but um,
[AGENT][NEUTRAL] I don't show any claims for pathology. Uh, like I said, we hadn't received any claims for [PII], only the 2 the 210 data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Well, lab charges are not covered on the policy. Um, type of policy you have with us is a limited medical indemnity plan and you have benefits for inpatient confinement, surgery where they done at facility or physician's office and diagnostic.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, I'm just gonna then uh I'm gonna just wait to uh.
[CUSTOMER][NEUTRAL] Till I get more until this 210 shows up with the explanation of benefits for the procedure because I don't have that on this sheet here it's basically showing me [PII] and 117.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, so until I have all that, then I'm gonna file an appeal for this. It's I, I don't understand that this insurance I have here is not covering anything. I just had blood work done a month ago and they're trying to charge me $200 to have some blood work done.
[CUSTOMER][NEUTRAL] Preventive doctor, yearly visit, physical blood work.
[CUSTOMER][NEGATIVE] I don't understand why I have to pay $200 for that in the previous time I paid $40.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, I'm not, uh, this insurance is a freaking joke.
[AGENT][NEUTRAL] I hear you and I understand, but it's, it's like I said, it's a limited medical plan, but it's very limited as the, what is covered. And like I say, you have benefits for inpatient facility, surgery, and for diagnostics.
[CUSTOMER][NEGATIVE] No, it doesn't cover anything.
[CUSTOMER][NEGATIVE] It doesn't cover anything.
[CUSTOMER][NEUTRAL] Yeah, but then, uh, how do you show me up to date with my current, uh, payment?
[AGENT][NEUTRAL] I'm showing your policy is active. Um, looks like you're with Benefits or their group. You can contact Benefits and a card and they can verify, um.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Specifically, if you're up to date.
[CUSTOMER][NEGATIVE] I'm just wondering if you can see any information there showing because I'm about to go on uh Medicare so I'm just I'm probably gonna cancel this early because I'm it's it's I'm wasting my money sending you guys money and I'm not getting nothing's getting covered so the money is getting, you know, wasted.
[CUSTOMER][NEUTRAL] Kind of like the government.
[CUSTOMER][NEUTRAL] You know what I'm saying?
[AGENT][NEUTRAL] I hear you.
[CUSTOMER][NEGATIVE] Yeah, this, it's horrible.
[CUSTOMER][NEGATIVE] Well, it's uh you can't do anything for me goodbye.