AccountId: 011433970860
ContactId: 50e1eb3b-6626-4500-81ce-c70add8f073f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351320 ms
Total Talk Time (AGENT): 127483 ms
Total Talk Time (CUSTOMER): 109616 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/50e1eb3b-6626-4500-81ce-c70add8f073f_20250305T15:48_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I have a policy number which is
[CUSTOMER][NEGATIVE] No longer active but um I have a doctor's bill here that y'all refuse to pay.
[AGENT][NEUTRAL] OK, what's your policy number that you have?
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 37639
[AGENT][NEUTRAL] OK, look at that one.
[CUSTOMER][NEUTRAL] You an explanation to the doctor's office saying that I had reached my
[CUSTOMER][NEUTRAL] Total amount of visits, but that was the first time I ever went to the doctors. Would you have y'all's.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let me take a
[AGENT][NEUTRAL] I'll look at it, Mr. [PII]. Can you verify your date of birth and your mailing address for me?
[CUSTOMER][NEUTRAL] Yeah, date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the mailing address [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] The document that you received from us, does it have a claim number on it?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Uh, it's not, it's not from you, it's from my doctor's office that y'all have refused to pay for it.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, let me look for that date of service.
[CUSTOMER][NEUTRAL] It should be the only one in there.
[AGENT][NEUTRAL] Uh-huh. I'm just needing to pull up the, the, the claim.
[CUSTOMER][NEUTRAL] No, I understand. I, I, I'm just saying, I mean, it's, that was the only time I went and used the insurance.
[AGENT][NEUTRAL] Right. Let's see.
[CUSTOMER][NEUTRAL] I pay every single week.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is this [PII] Internal Medicine?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for that date of service, uh, for the office visit, the benefit is, is $50 per day. We did make a payment to this location, um, for that date of service. It looks like they've submitted it several times, so that was processed and paid on [PII], and give me a second, let me look at these other ones.
[CUSTOMER][NEUTRAL] What do you, what do you mean by $50 per day? I've only been to the doctor's with y'all, with y'all's insurance one time.
[AGENT][NEUTRAL] I know it, so the, the, the benefit for each time that you go is $50 but you, you do have 4 visits or 4 days per calendar year. So I'm showing that you did just use the one for [PII].
[CUSTOMER][NEGATIVE] And I broke it then.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And we paid at 50 $50 which is the maximum per day.
[AGENT][NEUTRAL] And I'm actually showing 2. Give me a second.
[AGENT][NEUTRAL] Oh, I know what it is. We, there were 2 line items on your claim.
[AGENT][NEUTRAL] So we paid 11 visit and so there's 3 left for the year of [PII] but your benefit per day is $50 which is what was paid to your your provider.
[CUSTOMER][NEUTRAL] I mean, I don't, I don't understand what is $50 per day. What, what does that mean?
[AGENT][NEUTRAL] Each day you
[CUSTOMER][NEUTRAL] I mean, I wouldn't
[AGENT][NEUTRAL] Each day you go to the doctor. Yeah, it's a, it's an office visit. So each day,
[CUSTOMER][NEUTRAL] I wasn't in the hospital.
[AGENT][NEUTRAL] Each day you go to the doctor's office, the benefit is $50 each day.
[AGENT][NEUTRAL] You get to go 4 times a year, 4 days in a calendar year.
[CUSTOMER][NEGATIVE] OK, why, why was I not told about this and I paid $25 every single week.
[CUSTOMER][NEUTRAL] But the whole time I had your insurance and the only thing y'all paid was $50 out of a $371 bill.
[AGENT][NEUTRAL] Yeah, 4
[AGENT][POSITIVE] Yeah, that's, yeah, for the office visit, that is correct.
[AGENT][NEUTRAL] Because that's your policy, Maximus.
[CUSTOMER][NEUTRAL] I'm sure glad I ain't use y'all anymore.
[CUSTOMER][NEGATIVE] Yeah, but that's, that's not right. When you charge someone $25 every single week, you're paying $100 a month, but you only pay $50. I'm giving y'all probably 200 or $300 and y'all only paid $100 or $50.
[CUSTOMER][NEGATIVE] Y'all are getting out like a fat rat. You, you're screwing everybody over.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, this is actually the policy that your employer chose. We didn't choose the policy.
[AGENT][NEUTRAL] We're just administering it and processing the claims for the group that you were employed with.
[CUSTOMER][NEGATIVE] OK, I, I just would, I will make sure that nobody ever uses y'all again. Thank you for nothing.
[AGENT][POSITIVE] No, you're welcome, sir