AccountId: 011433970860
ContactId: 1e7024d2-e616-4fe6-b4c1-608625375be8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 818200 ms
Total Talk Time (AGENT): 236485 ms
Total Talk Time (CUSTOMER): 149427 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/1e7024d2-e616-4fe6-b4c1-608625375be8_20250428T14:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you this morning?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] I'm good. I'm calling for some more information because I put in a claim for hospital indemnity and I sent him the um what you call it the um itemized build.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um I also I don't know if they did they overlooked it about the anesthesia on the itemized bills also for the surgery.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So I'm trying to figure out what.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No, no, I'm just trying to make sure I follow you. OK, go ahead.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, so, um, um, they did, um, deposit.
[CUSTOMER][NEUTRAL] I think it was for let me see how much it was.
[CUSTOMER][NEUTRAL] Into my account.
[CUSTOMER][NEUTRAL] And I was wondering, did I need to do a separate one for the um anesthesia part or?
[CUSTOMER][NEUTRAL] Did they do it all together or what?
[AGENT][NEUTRAL] OK. Um, well, I can look at the claim for you and see um what's going on with the anesthesia part of it. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] um [PII].
[AGENT][NEUTRAL] Thank you for that. And do you have the claim number or the policy number?
[CUSTOMER][NEUTRAL] Yes, my policy number is 25,079,990.
[AGENT][NEUTRAL] OK, hold on one moment. Thank you for that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I have you here, Ms. [PII]. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is the verification of benefits, not a guarantee of payment, and um,
[AGENT][NEUTRAL] What's the last four numbers of the claim? Is it 2663 or 2665?
[CUSTOMER][NEUTRAL] OK, hold on, let me get back to that part.
[AGENT][NEUTRAL] Or it might be 2635. It looks like these all came in a few days from each other.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so what it's gonna do.
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] You said we paid out on it though. Was it $375 that we pay to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] So let me see about the other ones.
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold? I'm just looking at the claim and the charges and the denial reasons.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let's first pull up the policy to see what the benefit is because I need that screen so I can't go to PIPFT.
[AGENT][NEUTRAL] OK, so where is the policy, sir?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello Miss. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. So you were paid for the anesthesia benefit. It was paid $75?
[AGENT][NEUTRAL] The um.
[AGENT][NEUTRAL] Uh, so there's a total of 1234 codes on here. Anesthesia was paid $75. There were, there was one code that was charged twice, so we paid one, but we couldn't pay the other because it was the same code. And then the last code on here, um, you can only have, well, of the two surgeries, we paid the most expensive one, so the other one was denied because we applied to one surgery for that day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I mean for 2 surgeries. I'm not I only had one surgery.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] There's a surgery benefit that was used for, now what types of surgery? Um, I would, I, I have to look it up, but it's, it's called 58291.
[AGENT][NEUTRAL] Um, that
[AGENT][NEUTRAL] Surgery was paid $300. There's another code on here which is, it might be the same surgery, but these are separate surgery codes and this other one is 58925. So between the 58925 and 58921, those two surgery codes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One was $3,911 the other was $2,314 so we paid on the $3000 bill because that was more.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, so I just wanted to make sure um.
[CUSTOMER][NEUTRAL] It was paid.
[AGENT][NEUTRAL] Yes, ma'am, I understand, especially with the bills coming in, every penny counts.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you're paying for it.
[CUSTOMER][NEUTRAL] You got
[CUSTOMER][NEUTRAL] Yes, so they're supposed, did they apply what, um, $1000 towards it, the anesthesia?
[AGENT][NEUTRAL] No, no. So the anesthesia, so your, your anesthesia benefit, whatever your total for your uh surgery is, your anesthesia benefit is 25% of whatever the surgery amount was.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So the $75 was applied to the anesthesia benefit and then $300 was applied to the surgery.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, I think that was it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL.
[CUSTOMER][NEUTRAL] Oh, let me ask you a question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So let me ask you this question. One moment. OK, so being that um I am not at work right now and they cannot take it out of my
[CUSTOMER][NEUTRAL] Um, I, um, my check, do I have to pay y'all directly or?
[CUSTOMER][NEUTRAL] Do y'all get that when I go back to work?
[AGENT][NEUTRAL] Well, so the payment's not gonna go to us, it would go to either the hospital or doctor's office that you went to.
[CUSTOMER][NEUTRAL] No, I'm talking about about about my deductibles.
[AGENT][NEUTRAL] 000, like your monthly payments, like your premium. OK, hold on one moment. Let me see what it's on.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Let me read the fine print. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I don't know, she don't have a waiver.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Miss [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thanks so much for holding. So you would still pay it to your HR department because you're still um on the group invoice for their payroll deduction, so you would pay it to your HR.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, that'll be it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.