AccountId: 011433970860
ContactId: 5c77d326-56b4-4180-8252-93cac1b6f86e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500690 ms
Total Talk Time (AGENT): 238091 ms
Total Talk Time (CUSTOMER): 226931 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/5c77d326-56b4-4180-8252-93cac1b6f86e_20250505T21:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling and APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name is [PII], and I have a question about a statement I received from you guys.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with your um statement questions. Uh, can I please get your callback number, ma'am, just in case the call gets dropped, I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Yep, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your policy number?
[CUSTOMER][NEUTRAL] Um, 02485964.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then also your address, phone number and email address that's on file for you.
[CUSTOMER][NEUTRAL] Uh, I don't know all that, um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I don't know what email address I have with you guys.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Yeah, I have like 5 accounts and my business account and my medical.
[AGENT][NEUTRAL] Oh no, OK, I'll let you know.
[AGENT][NEUTRAL] There is the word helper.
[CUSTOMER][NEGATIVE] It's either crap
[CUSTOMER][NEUTRAL] Oh, [PII] or [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Yes, that's correct. And then I did notice that the phone number that you gave me to call you back on, uh, is that your cell phone number, Ms. [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] It sure is.
[AGENT][POSITIVE] OK. Thank you for verifying your policy for me, ma'am.
[AGENT][NEUTRAL] OK, you said that you received a statement and you just had questions about it?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Yes, well, it's an explanation of benefits.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Or the lack thereof.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's dated [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it says the outpatient.
[AGENT][NEUTRAL] Let me look that. Mhm.
[CUSTOMER][NEUTRAL] The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or a physician office, therefore, no benefits are payable.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, I had, I had the procedure in the physician's office, so I'm.
[CUSTOMER][NEGATIVE] Really confused where you guys think I had it.
[AGENT][NEUTRAL] OK, um, well, let me look real quick um because it goes by what the physicians.
[AGENT][NEUTRAL] Um, the itemized statement that is sent in from the um physician.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let me give you the procedure codes maybe you can call them and let them know.
[AGENT][NEUTRAL] What your EOB state?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is um the first procedure code is 99214.
[CUSTOMER][NEUTRAL] 214.
[AGENT][NEUTRAL] And that charge amount
[AGENT][NEUTRAL] was 396 56.
[AGENT][NEUTRAL] And then the second procedure code was 99459 and that charge amount was $70.04.
[AGENT][NEUTRAL] So according to the itemized statements sent in, those are the procedure codes that they used.
[CUSTOMER][NEUTRAL] OK. Can you repeat that last procedure code?
[AGENT][NEUTRAL] And if it was
[AGENT][NEUTRAL] Absolutely, it's
[CUSTOMER][NEGATIVE] Cause my phone cut out.
[AGENT][NEUTRAL] That's OK. It's 99459.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's what was sent in so we have to use the procedure codes that they send in to us now if they made an error and I used the wrong procedure code they can send in a claim correction to us. There's not a timely filing limit on that, but they'll just need to send a letter why they want to correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so they have to like mail you guys a letter they can't just call you?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Or OK.
[CUSTOMER][NEGATIVE] Yeah, cause I got a bill for $500 and some dollars and they said nothing was covered and I'm like.
[CUSTOMER][NEUTRAL] Where do they think I have to start out in the parking lot?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And I'm just like, oh my God, you know.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][MIXED] I, I have to tell you, you know, the, this insurance company is the worst, but it has amazing customer service, so it makes it easier to deal with.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yes ma'am, thank you.
[CUSTOMER][NEUTRAL] But it's like
[CUSTOMER][NEGATIVE] I, I wish they had things more clear cut.
[CUSTOMER][NEUTRAL] Um, online.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because I don't like, you know, I can't call you guys in the middle of the night when I have a question.
[AGENT][NEUTRAL] Right, are you signed up?
[CUSTOMER][NEUTRAL] And stuff and, and, and then,
[AGENT][NEUTRAL] Have you signed up for the online service center because if you're.
[CUSTOMER][NEUTRAL] Uh, yes, I, I
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I was gonna say because your policy certificate should be on the online service center so like if you have questions in the middle of the night and they're driving you crazy and you can't sleep because the questions are in your head, um, you can always get on that online service center um get your policy out and read it and it should answer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] The questions you may have at that time.
[CUSTOMER][NEUTRAL] I actually have that printed out because it's not very explanatory, um.
[AGENT][POSITIVE] Oh, good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It, it has very little information and I'm like,
[CUSTOMER][NEGATIVE] I'm gonna die on this insurance.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I'm, I'm frantically trying to find a new job so that I can get new insurance cause it's like.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] It, it's frustrating. Um.
[AGENT][NEUTRAL] Yes, I understand.
[CUSTOMER][POSITIVE] But every time I call you guys they're always so amazing, so it's like, OK. Customer service is gonna make it right.
[AGENT][POSITIVE] Oh, well, thank you. That's such a good compliment.
[AGENT][POSITIVE] Yes, and you know we'll help you so like if you have questions about your certificate, always feel free to pick up the phone and ask us and we'll go over it with you.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK. Yup. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I will do that. Well, thank you for your help. I'm gonna call the clinic right now then and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Be like, hey, can you guys fix this? I mean, even if you cover $50 it's better than.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] 500 or whatever they said my bill was so.
[AGENT][NEUTRAL] Yes, ma'am, and I don't know if a mistake was made or not, but just in case one could have been made, it's, they can just send in a corrected claim with a letter.
[CUSTOMER][NEGATIVE] Cause I don't
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. All right. I have that written down so I don't forget. So, well, thank you so much for your help. Hopefully I can get it all fixed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII].
[AGENT][NEUTRAL] Well, you
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. I hope you get it fixed too, ma'am.
[CUSTOMER][POSITIVE] All right. Well, thank you. Take care.
[AGENT][NEUTRAL] Is there
[AGENT][POSITIVE] You take care too, and thanks for calling APL Ms. [PII]. You have a good week.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.