AccountId: 011433970860
ContactId: 81bb4676-1c30-4b4b-967e-a2d8d3fca757
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310799 ms
Total Talk Time (AGENT): 106901 ms
Total Talk Time (CUSTOMER): 118644 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/81bb4676-1c30-4b4b-967e-a2d8d3fca757_20250319T19:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes. My name is [PII] and um
[CUSTOMER][NEUTRAL] Last year my husband [PII].
[CUSTOMER][NEUTRAL] Had insurance coverage through you guys. It was through um innovativeta Solutions.
[CUSTOMER][NEUTRAL] And um I'm trying to get something cleared up. Um, I had to have a cardiac monitor. It was approximately sometime last spring.
[CUSTOMER][NEUTRAL] Um, the company that.
[CUSTOMER][NEUTRAL] Provided the heart minders saying they can't get the billing information correct.
[CUSTOMER][NEGATIVE] And that their claim keeps on getting denied for this cardiac monitor.
[CUSTOMER][NEGATIVE] So I'm trying to call and find out what the problem is because um I had told my physician ahead of time that if my insurance would not cover it, I was not gonna get it done. The hospital said they got it pre-approved through your insurance company, that it was gonna be covered.
[AGENT][NEUTRAL] Well, we, our company don't pre-approve anything, but Ms. [PII], what's your policy or what was the policy number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The group number or?
[AGENT][NEUTRAL] Policy slat start number starts with a 01 or 02.
[CUSTOMER][NEUTRAL] I've got a group number.
[CUSTOMER][NEUTRAL] There's nothing like that on this card. There's a group number, employee ID number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A medical claim submission payer ID number.
[AGENT][NEUTRAL] No, ma'am. Um, and you say your last name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. The address is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. Well, under your policy, it's a limited medical indemnity plan. Um, we don't
[AGENT][NEUTRAL] Pre-cert or give any
[AGENT][NEUTRAL] Authorization for any procedures or monitors and your policy doesn't cover any
[AGENT][NEUTRAL] Monitors or DME durable medical equipment.
[CUSTOMER][NEGATIVE] Well, what did it cover because nothing ever got paid on any of my bills. I had to pay for everything out of pocket.
[AGENT][NEUTRAL] Let's see, under the policy.
[AGENT][NEUTRAL] I sure you had benefits for inpatient confinement, um.
[AGENT][NEUTRAL] Outpatient sickness benefit rider like for ER urgent care office visits, and you had a wellness diagnostic benefit on the plan.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So basically, the insurance didn't cover anything. We paid for nothing.
[AGENT][NEUTRAL] Well, it paid, it covers some things, but not a lot of things weren't covered, like you had benefits for office visits that we've paid or if you had diagnostic, like an MRI, CT, CAT scan, uh, confinement in the hospital, those services are covered.
[CUSTOMER][NEUTRAL] All right, so basically my provider got something for me that was never pre-authorized to you guys.
[AGENT][NEUTRAL] Well, we don't pre-authorize anything, no, ma'am.
[AGENT][NEUTRAL] So I'm not sure who they spoke to to have anything pre-authorized, but we don't authorize or pre-authorize anything.
[AGENT][NEUTRAL] If they were to call to verify benefits, they would explain it's not covered under the plan.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, they didn't do that. They said it, it was gonna be covered is what they told me.
[AGENT][NEUTRAL] OK. Well, is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't know, that was it.
[AGENT][POSITIVE] OK, uh, uh thank you for calling APL. You have a great day.
[CUSTOMER][POSITIVE] All right thank you bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye.