AccountId: 011433970860
ContactId: 1f5ad7f1-75e1-4813-8254-e0cc4aed7b56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501010 ms
Total Talk Time (AGENT): 116814 ms
Total Talk Time (CUSTOMER): 188392 ms
Interruptions: 2
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/1f5ad7f1-75e1-4813-8254-e0cc4aed7b56_20250430T20:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I have a lapse coverage with you guys and I've been seeking reimbursement first.
[CUSTOMER][NEUTRAL] Uh, services rendered way back in, uh, the end of [PII], and, uh, I submitted with with the help of a representative I spoke with the other day I submitted, uh, I think the remaining documentation you guys are missing which was uh diagnosis codes for some procedures.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I thought that I submitted um.
[CUSTOMER][NEUTRAL] Codes that would have covered procedures totaling my my full reimbursement which is $2500 and I, I did get a payment from you guys the other day but it was uh it was $1000 which brings the total you guys have paid out $1600 but I was expecting $2500 so I'm wondering if maybe I didn't, I, I don't know, I'm wondering if you can help me figure out what, what, uh.
[CUSTOMER][NEUTRAL] If you're missing diagnosis, which, which ones you're missing still or what the deal is.
[AGENT][NEUTRAL] Yeah, I can definitely look into the claims.
[CUSTOMER][NEUTRAL] Or may
[CUSTOMER][NEUTRAL] Yeah, I was gonna say it's possible I suppose that you guys have just processed only some of them and so I got a partial payment and maybe they'll be more coming but if you could.
[CUSTOMER][POSITIVE] If you could help me find out if that's the case, that would be good. Thank you.
[AGENT][POSITIVE] Yes, I definitely can assist you with your claims. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[CUSTOMER][NEUTRAL] And my uh phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Yeah, my policy number is 2321238.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII]. My mailing is [PII].
[CUSTOMER][NEUTRAL] And what was the last thing?
[AGENT][NEUTRAL] Your email address. Mhm.
[CUSTOMER][NEUTRAL] Email [PII]. Oh no, you, you probably have, excuse me, you probably have [PII].
[AGENT][NEUTRAL] All right, thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And do you mind if I place you on just a brief hold while I look at the claim and see what what's going on?
[CUSTOMER][NEUTRAL] Yeah, sure, just, just for your references, I think the one that contains most of these claims that should have totaled 2500 were um is is the 340-1682. It's the the second to oldest claim I think um but it looks like you guys paid out a different one so I don't even know uh yeah if you could take a look please put put me on hold by all means.
[AGENT][NEUTRAL] I'm sorry, what claim number, hold on one second. What claim number did you just give?
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] 340-1682 I think that's the one that had, yeah, but you guys paid out a different claim, so I'm not sure.
[AGENT][NEUTRAL] Oh, there it is. OK.
[CUSTOMER][NEUTRAL] Oh no, you paid out the one I submitted the other day. OK, OK, I see, uh, yeah, so that makes sense because I submitted the diagnosis codes, but I think the diagnosis codes I submitted pertains to that one I just gave you 340-1682.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me look at them. Hold on one moment, OK?
[CUSTOMER][POSITIVE] Thank you. Take your time.
[AGENT][POSITIVE] You're very welcome. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Hello hi.
[AGENT][NEUTRAL] Alright, thanks so much for holding. I apologize for the wait, but I do have an answer for you. So, the um, oh Lord, hold on, let me put the put the other screen. I'm sorry, I'm working with three screens. OK, so the claim number 3401682. OK, so that was the very first original claim. Everything that was filed under that claim is what was processed on 359-5300.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, it's OK, don't worry.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now you have a calendar day max for outpatient expenses of $600. Your $2500 is for inpatient if you're admitted to the hospital. You have $2500 for inpatient benefits, but for outpatient, you have $600 a day. So that's where the $1000 is coming from. For [PII], um, the policy pays $600.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then for [PII], the charge was $400 so we paid that full $400.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, so inpatient, OK. I, I.
[CUSTOMER][POSITIVE] Spend a lot of time in the medical system, so I'm trying to now I'm trying to rack my brain just to see if I have anyway I'll, I'll figure that out um that's useful. Thank you very much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thanks so much you've been very helpful.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL and I hope you have a great evening.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Thank you. Bye-bye.