AccountId: 011433970860
ContactId: 7d4a7be9-a12f-4110-a146-dc0e551b8ab2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291739 ms
Total Talk Time (AGENT): 87765 ms
Total Talk Time (CUSTOMER): 172092 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/7d4a7be9-a12f-4110-a146-dc0e551b8ab2_20250313T19:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, um, I'm trying to kinda figure something out, um, just to double check, um, that my, I don't have coverage, um, you know, for this, um, and, um.
[CUSTOMER][NEUTRAL] Hold on one second and then I can tell you um.
[CUSTOMER][NEUTRAL] Um, OK, so I am getting, um, allergy injections, and, um, apparently, um, there is, and I have you guys as my gap insurance, and I know you don't cover for doctor visits, um, but I didn't know when they have to mix and prepare the treatment. Is that something that you guys cover or don't cover? because I know sometimes you cover tests and.
[CUSTOMER][NEUTRAL] You know, treatment stuff and so forth.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] You have your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have to
[AGENT][NEUTRAL] Or I can look it up by your social.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see if I have it.
[CUSTOMER][NEUTRAL] It is 01677458 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK, and what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Let's see [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And you were just wanting to know if we cover the allergy injections?
[CUSTOMER][NEUTRAL] Yeah, so like, not just the injections when I go in to receive it, but they have to prep the treatment.
[CUSTOMER][NEUTRAL] And then I receive when I go in.
[CUSTOMER][NEUTRAL] So there's like a, you know, kind of like every so often, they have to prepare it.
[CUSTOMER][NEUTRAL] And so they're um my primary is covering some or whatever of it you know and then there's a remaining amount and I'm wondering if they should be sending you guys that.
[CUSTOMER][NEUTRAL] Before I pay it out of pocket, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with that. Yes, ma'am, they can send it to us. They can always send it to us and let us look at it. Now, this policy does cover um
[AGENT][NEUTRAL] Service is done in a doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it just don't cover the office visit. Now, it would be covered under your outpatient benefit. Whatever your primary applies to your deductible copay or co-insurance will pay up to $1000 per calendar day.
[CUSTOMER][NEUTRAL] So here's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so they said that they turned it into you guys. It's a data service of 8:15-2024.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] It says, you know, prep.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] J and allergen, um,
[CUSTOMER][NEUTRAL] Therapy and that's what that, I guess that is what that is, immunotherapy.
[AGENT][NEUTRAL] They said they sent a claim to us.
[CUSTOMER][NEUTRAL] Yeah, so they told me, so basically, I was confused because um
[AGENT][NEUTRAL] I don't see a claim for that data service.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, did you see one for 10:17?
[AGENT][NEUTRAL] 1017.
[CUSTOMER][NEUTRAL] Uh again in 2024.
[CUSTOMER][NEUTRAL] Obviously that would be in the future.
[AGENT][NEUTRAL] OK. 1017 for an office visit and for some other codes.
[CUSTOMER][NEUTRAL] Yeah, OK, so they sent you the wrong one.
[AGENT][NEUTRAL] Um, now I do see some for like 101 for, hold on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the injections, then we have a lot of those.
[AGENT][NEUTRAL] And but
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the only thing we have in.
[CUSTOMER][NEUTRAL] OK, so you don't have 8:15. So basically they, which I knew you wouldn't do a doctor's visit, which is what [PII] or whatever the date I just gave you the October date, but [PII] they said that was when they were prepping it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I don't see a claim for that.
[CUSTOMER][NEUTRAL] Inside the doctor's office, so, OK, so have them resend that over to you guys because you don't see it.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] OK, all right, I appreciate it thank you so much. All right, bye bye.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you. Have a good day. Mhm.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good day as well.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye.