AccountId: 011433970860
ContactId: 88854829-3e6d-44b1-9e7e-1389963d8ca1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 892780 ms
Total Talk Time (AGENT): 269317 ms
Total Talk Time (CUSTOMER): 402110 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/88854829-3e6d-44b1-9e7e-1389963d8ca1_20250331T16:13_UTC.wav
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[AGENT][POSITIVE] Thank for calling ATL this is may I help you?
[CUSTOMER][NEUTRAL] Hi how are you?
[AGENT][POSITIVE] I'm good how are you doing this morning?
[CUSTOMER][NEUTRAL] Good, thank you. Um, I'm calling in regards to some medical, um.
[AGENT][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Uh, 2 medical claims I put in.
[AGENT][NEUTRAL] OK, I can help you with your claims. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Sure, so let me give you the policy number, wouldn't that help?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] To pull all my information up? OK, so I have that dental.
[CUSTOMER][NEUTRAL] Give me 2 seconds here, so.
[CUSTOMER][NEUTRAL] Dental, give me 2 seconds. Print. Let me just pull up my folder here.
[AGENT][POSITIVE] Yes, go ahead and take your time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Um, the
[CUSTOMER][NEGATIVE] Uh, card number, group number that wouldn't help.
[CUSTOMER][NEUTRAL] Um, ID number 681 9.
[CUSTOMER][NEUTRAL] 30835 [PII].
[AGENT][NEUTRAL] OK, do you see another number on because that is one of our policy numbers.
[CUSTOMER][NEUTRAL] Oh, the you need the claim number itself, right? The claim? OK, so I.
[AGENT][NEUTRAL] No, the policy number of your dental policy?
[CUSTOMER][NEUTRAL] Oh, this isn't for dental, this is for medical.
[AGENT][NEUTRAL] Oh, for medical. OK.
[CUSTOMER][NEUTRAL] Actually, you know what, what's interesting is
[CUSTOMER][NEGATIVE] I've been trying to call for dental, for dental reimbursement, and I've never been able to get on.
[CUSTOMER][NEUTRAL] With someone in regards to a dental claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Who would I send a dental claim to?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, usually the dental office sends it in, um, because we don't have claim forms for dental, so it's done by the provider.
[CUSTOMER][NEUTRAL] Yeah, no, but where, OK, so that's the case because this is for cleaning, where would they send that to?
[AGENT][NEUTRAL] Uh, they would send it to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] And can
[AGENT][NEUTRAL] And can you spell your first and last name for me so I could pull up your policy?
[CUSTOMER][NEUTRAL] Sure. [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Easy and before we move forward you said [PII] box, but who's attention?
[AGENT][NEUTRAL] APL claims.
[CUSTOMER][POSITIVE] APO claims OK great.
[CUSTOMER][NEUTRAL] Oh, I see it's right here 73214-8950. It's on here from the check. OK, perfect. um I had sent two claims um.
[CUSTOMER][NEUTRAL] Out
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I got a check the other day.
[CUSTOMER][NEUTRAL] What would help you from this information?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, first
[CUSTOMER][NEUTRAL] Check number policy oh there's a policy number on here.
[AGENT][NEUTRAL] Yes, what is your policy number? We'll need to verify your policy.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] Sure it has here 02470321.
[AGENT][NEUTRAL] OK, let me look up that policy number real quick, Ms [PII].
[CUSTOMER][NEUTRAL] Oh, so this is different. The members one thing and then the policies is another. I thought it was one of the same, very confusing. I'm not on any of this medical anymore, but anyway.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Um, I think it's [PII].
[CUSTOMER][NEUTRAL] Uh, what else? My email, uh, contact shy.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, what is it? I shy I forget this one because it's new.
[CUSTOMER][NEUTRAL] I used to use the [PII].
[CUSTOMER][NEUTRAL] Give me a second. What happens when you have so much, OK, here we go. Yeah, [PII], uh, oh, yeah, OK, so it's [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then one last verification, can you give me your phone number?
[CUSTOMER][NEUTRAL] Uh, I'm not sure which one you have. It's my cell and my home numbers. Do you have a it starts with either so if it starts with [PII], that's my home. If it starts with [PII], that's my cell.
[AGENT][NEUTRAL] OK, uh, give me the cell phone.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying your policy for.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that you received a check.
[CUSTOMER][NEGATIVE] I received a $100 check um Friday or something or whatever, but you know it says here outpatient ACC sickness this is incorrect, this is incorrect these are um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Allergy shots, so I don't know why they have you have it coded as outpatient ACC sickness because this should be covered much more than that because when I call claims they inform me let me look at my um notes, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They informed me that I OK so here for.
[CUSTOMER][NEUTRAL] They said so they for the [PII] visit you guys need an itemized statement which I got from the allergist and I attached it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, let me see here and then.
[CUSTOMER][NEUTRAL] For the 429 I was informed to also send a statement and ask for a full reimbursement, so I'm not sure I think something got wrong in the coding here.
[AGENT][NEUTRAL] OK, so the policy that you used to have with us is a hospital indemnity plan and this is just to verify if it's not a guarantee of payment. The hospital indemnity plan is a set amount for a covered procedure. So for your outpatient, the $50 was the maximum payable.
[CUSTOMER][NEUTRAL] This is, this is for allergist, yeah, no, yeah, but this is for allergy, so as a matter of fact.
[CUSTOMER][NEUTRAL] It's quite a few visits on this allergist invoice and let me see here.
[CUSTOMER][NEGATIVE] How you guys paid because I think the codes are incorrect.
[CUSTOMER][NEUTRAL] So let's say for instance on [PII].
[CUSTOMER][NEUTRAL] There was.
[CUSTOMER][NEUTRAL] Uh, visit $50 you guys, I had to pay $13 from that visit, I think. So I, I'm not sure if this is coded correctly. So from the [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think either my statement, I think there was a 511 and 50 cents.
[CUSTOMER][NEUTRAL] Um, um, due amount, how could you just pay $50 from an allergist appointment? That doesn't make sense when it says outpatient here.
[AGENT][NEUTRAL] OK, so, so.
[AGENT][NEUTRAL] Right. So outpatient.
[AGENT][NEUTRAL] Your, your policy.
[AGENT][NEUTRAL] is a set amount for a covered procedure. So on your outpatient for accident or sickness, the set amount is $50.
[CUSTOMER][NEUTRAL] For allergist? For allergy?
[AGENT][NEUTRAL] For outpatient procedures for accident or sickness, treatment benefit is $50.
[AGENT][NEUTRAL] On your policy.
[AGENT][NEUTRAL] So the policy pays $50 even and and not saying that this is what happened, but even if you had gone and your charge was only the $5 we would still pay the $50. If the charge was $100 we would still pay the $50.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] I don't know why you're saying that because on $129 on 129 there was a charge of $50 you guys didn't pay it.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Because I'm left paying them $13.44.
[AGENT][NEUTRAL] OK, so, um, the way your policy is written is.
[AGENT][NEUTRAL] For indemnity, indemnity means a set.
[AGENT][NEUTRAL] Uh, amount for a covered procedure. So the set amount for your covered procedure for outpatient sickness or accident treatment in a physician's office is $50.
[CUSTOMER][NEUTRAL] This has nothing to do with an accident. It has to do with allergist treatment, allergy shots.
[AGENT][NEUTRAL] Right, which follows, which falls under sickness, which falls under sickness.
[CUSTOMER][NEUTRAL] I don't understand, isn't that different?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So that's all you guys are covering from this $1 amount? $50.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I can't believe what I paid for a month for this policy and you guys covered almost nothing and that's not what I was informed.
[CUSTOMER][NEUTRAL] That's crazy.
[CUSTOMER][NEUTRAL] That really it's crazy.
[CUSTOMER][NEGATIVE] So why would someone at your agency tell me to submit.
[CUSTOMER][NEUTRAL] For the full reimbursement for the 429 appointment.
[CUSTOMER][NEUTRAL] Which was a balance 47,880 I think after whatever pennies you guys paid.
[AGENT][NEUTRAL] OK, um, I can't answer for what somebody else said to you here, but what I can do is I can get you further help. I can have somebody from the claims department, a benefit, um, examiner, give you a call back and go over the claim with you. OK, all right, and what's a good.
[CUSTOMER][POSITIVE] Yeah, that would be great.
[CUSTOMER][POSITIVE] Yeah that'd be great.
[CUSTOMER][POSITIVE] You could call my, you could call my house number. It's more convenient.
[AGENT][NEUTRAL] OK, and what is that number, please?
[CUSTOMER][NEUTRAL] Uh, it's the one showing [PII].
[AGENT][NEUTRAL] [PII]. OK, I'm gonna put you on a brief hold while I look while I get this uh submitted for you for you to get a call back and I'll be right back.
[CUSTOMER][POSITIVE] I appreciate that.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], I have that request in for you to get a call back and you should be receiving a phone call from a claims examiner within 24 hours.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Great. Uh, quick question, ma'am. The dental, the dental claim, can I email that to the customer support um at [PII] [PII]? Can I email that invoice or no?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, looking at your policies, I do not show that you have, uh, dental coverage with our company.
[AGENT][NEUTRAL] So on your dental card, look at the back of it and see if there's an address or a phone number that you can call there.
[CUSTOMER][NEUTRAL] Oh, so the
[CUSTOMER][NEGATIVE] Yeah, there is a number, but it rings off the it's, it's busy, busy busy, which it doesn't make any sense, OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Great thank you so much appreciate your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there any other questions or anything else that I can help you with before we go?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] Well, we appreciate you and thank you so much for calling APL. Have a good rest of your week.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye, ma'am.