AccountId: 011433970860
ContactId: 232cc856-c92d-498c-87fd-e42afaf0a254
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349109 ms
Total Talk Time (AGENT): 139996 ms
Total Talk Time (CUSTOMER): 133349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/232cc856-c92d-498c-87fd-e42afaf0a254_20250306T17:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I was calling to see actually what is, what benefits are covered under my policy.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] 579-094
[AGENT][NEUTRAL] Repeat that policy number again.
[CUSTOMER][NEUTRAL] 02579094
[AGENT][NEUTRAL] [PII], could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], what is the email address that we don't have one? Thank you. Would you like to put an email address on file?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] What would you like it to be?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let's go with [PII]
[CUSTOMER][NEUTRAL] [PII] unique
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I have [PII] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're calling to verify your benefits, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] When I when I give my regular insurance card to my providers and I give them this, I always get a letter from you guys saying this service or whatever and then it was claim denied so I don't know.
[CUSTOMER][NEUTRAL] What this car, what what the policy entails.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, so your policy has outpatient benefits of $1000 per calendar year. And when I say outpatient, meaning as in physical therapy, um, lab, diagnostic testing, outpatient surgery.
[AGENT][NEUTRAL] Um, inpatient, you have 5000 per calendar year, and this is for anything that's 18 hours or over in the hospital stay, and this is not a guaranteed benefits just a disclaimer or your policy's coverage so your outpatient has covers like urgent care, the ER visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, what else?
[AGENT][NEUTRAL] I know your office visits are not covered or your treatment received in the office is not covered.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I had a surgery last year, a septoseptoplasty, and they had the car, and I don't know if that would if they denied it or not, I can't remember if I got a letter for it now, but that would have been covered.
[AGENT][NEUTRAL] Do you remember the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing anything on file for [PII].
[CUSTOMER][NEUTRAL] Really, uh, uh, should I send in something or how does that work?
[AGENT][NEUTRAL] Yeah, you can request the itemized bill from them listing the diagnosis and then your ELB from your primary insurance company which is your explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that surgery did it take your explanation of benefits from your primary insurance company and your um itemized bill from your provider listing your diagnosis codes for the surgery.
[CUSTOMER][NEUTRAL] So I need an EOB.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and it was the outpatient I did they I did it in the hospital and then they sent me home the same day.
[AGENT][NEUTRAL] Got you, OK.
[AGENT][NEGATIVE] It, it should have been covered if it's.
[AGENT][NEUTRAL] If they, I'm not sure why they didn't submit a claim. Did you provide them with your secondary insurance?
[CUSTOMER][NEUTRAL] Yeah, they have my secondary and my um.
[CUSTOMER][NEUTRAL] Regular insurance card, so I don't know why he didn't do it. I don't know.
[CUSTOMER][NEUTRAL] But I will definitely get the itemized in the EOB.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] So I know it doesn't quite as the hospital visits, but anything like um hospital stays, outpatient stay.
[CUSTOMER][NEUTRAL] Um, urgent care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] ER visits, diagnostic testing, physical therapy.
[CUSTOMER][NEUTRAL] Yeah, they
[CUSTOMER][NEUTRAL] OK, yes, OK, so let's say it would not hand uh cover chiropractic care, would it?
[AGENT][NEUTRAL] No, ma'am, because you don't have treatment received in the office.
[CUSTOMER][POSITIVE] OK, OK, alright, that's all I wanted to know. I was just like, why is he sending me letters saying it was denied? I was like, because I didn't know what it covered. I got it now. I appreciate you, [PII], right?
[AGENT][NEUTRAL] Is there anything else that I can assist you with today? Yes, ma'am.
[CUSTOMER][NEUTRAL] That's all, so where do I send those um documents to?
[AGENT][NEUTRAL] You can upload them to [PII] if you um sign up for your own account.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Yeah, I believe I have an account. OK, I'll do that thank you so much, dear.
[AGENT][POSITIVE] Alright, thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] You too dear. Bye-bye.
[AGENT][POSITIVE] Thanks bye bye.