AccountId: 011433970860
ContactId: 424eeafb-657c-440c-82c0-997f7fdeb374
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436119 ms
Total Talk Time (AGENT): 150304 ms
Total Talk Time (CUSTOMER): 156500 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/424eeafb-657c-440c-82c0-997f7fdeb374_20250415T16:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Yes, uh, I kind of received like a bill what is covered or not, um, but it says that that you guys are waiting for a card payment or something. I don't, I don't understand it.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do. My, my, OK, yeah, this thing's so small, uh, what I just do with it? OK. uh D 43732222.
[AGENT][NEUTRAL] Um, and what is your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] How does she
[AGENT][NEUTRAL] Um, [PII]
[CUSTOMER][NEUTRAL] Yep, [PII]
[AGENT][NEUTRAL] OK. And your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you received the uh.
[AGENT][NEUTRAL] Correspondence from us or what was it?
[CUSTOMER][NEUTRAL] Yes, I got, I actually got 3 different ones in the mail.
[CUSTOMER][NEUTRAL] Cause it says for non-coverage uh procedure. Well, mine is, uh, for my, uh, high blood pressure and my uh diabetes. So that is pretty, uh,
[AGENT][NEUTRAL] OK. Do you have a
[CUSTOMER][POSITIVE] Pretty much needed
[AGENT][NEUTRAL] Does it have a claim number on it?
[CUSTOMER][NEUTRAL] Yes, ma'am. This one it says 357-9383.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I got got 3 different ones sitting here.
[AGENT][NEUTRAL] And [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh, yeah, uh [PII].
[AGENT][NEUTRAL] I've got several policies on here, so I'm just trying to figure out which one I'm gonna be looking at. Hold on one moment.
[CUSTOMER][NEUTRAL] Because I'm still through the [PII] so because I've only been there like 7 months.
[AGENT][NEUTRAL] And what is your birthday?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I just need 2 more pieces of information, your address?
[CUSTOMER][NEUTRAL] It's [PII], and it's [PII].
[AGENT][POSITIVE] OK, thank you. And lastly your email address.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you. OK, let's see what we got here. OK, so.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, I'm looking at that 357-9383, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me see what we received.
[CUSTOMER][NEUTRAL] Yeah, because see I had to go through a new doctor since uh you guys weren't under the sign through uh.
[CUSTOMER][NEUTRAL] Uh, Parkview stuff like that, so I had to switch doctors.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I went for my initial blood work and everything to get it going and but that's the only bill I've gotten it but.
[CUSTOMER][NEGATIVE] Seems it's not getting covered.
[AGENT][NEUTRAL] OK. So it looks like they just did a blood draw.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] It looks like it's not covered under the policy, but let me pull up your policy real quick.
[AGENT][NEUTRAL] So this is your hospital indemnity plan.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Basically, what it covers is hospital admission, confinement, surgery.
[AGENT][NEUTRAL] And then diagnostic testing.
[AGENT][NEUTRAL] Um, a blood draw is not considered under diagnostic testing.
[AGENT][NEUTRAL] Uh, so diagnostic
[CUSTOMER][NEUTRAL] Yeah, but uh.
[AGENT][NEUTRAL] It would be like MRI, CAT scan, PET scan, um, that would be what diagnostic testing would be.
[CUSTOMER][NEUTRAL] OK, so that means I, I have to pay out of pocket that.
[AGENT][NEUTRAL] Uh, unless there's some other insurance that you have, um, like a major medical or something.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] I mean, that's what insurance is supposed to be for. I mean, this is something I have to do every 3 months.
[AGENT][NEUTRAL] Yeah, it, unfortunately, like I said, the what it defines as a medical imaging test or diagnostic testing, it would be, like I said, like an MRI, a CAT scan, you know, things like that, not just a venal puncture, which is a blood draw.
[CUSTOMER][NEUTRAL] OK. Does that cover my like doctor's visit?
[AGENT][NEUTRAL] Um, let's see. So you've got a benefit for
[AGENT][NEUTRAL] The um hospital admission, and this is not a guarantee of payment, it's a basic outline. Um, so if you're admitted to the hospital, um, if you're confined to the hospital like inpatient.
[AGENT][NEUTRAL] Uh, it pays for surgery in a hospital, surgery in a physician's office, um, again, diagnostic testing.
[AGENT][NEUTRAL] Um, I, I see coverage for surgery in a physician's office, but not the actual office visit itself.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] OK, then, uh, that makes no sense and I mean, then, then a person doesn't, isn't covered that has something that's life threatening. That's crazy.
[AGENT][NEUTRAL] Is this through your employer or did you get this um let me see.
[CUSTOMER][NEUTRAL] No, this is through the employer MAU.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like, yeah, so this, they don't offer a major medical. This is a hospital indemnity, so it is a limited supplemental policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I needed to check on.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, nope.
[AGENT][POSITIVE] OK. Thank you for calling APL. I hope you have a good day.