AccountId: 011433970860
ContactId: 8a69e626-7b26-40c3-af35-bebe069cb516
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464600 ms
Total Talk Time (AGENT): 144714 ms
Total Talk Time (CUSTOMER): 156525 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/8a69e626-7b26-40c3-af35-bebe069cb516_20250407T18:56_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello. Um, I am calling about, um, some, uh, my husband was in the hospital in last September for heart surgery, and a few of the bills, the doctor visits didn't get covered. And so we were told we needed to call you guys and find out why they weren't covered and what we need to do. Maybe there's somebody else we're supposed to file it with.
[CUSTOMER][NEUTRAL] Um, so what do we need, so what do you need from me?
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] OK, I can check and see if we received the claim, if we process or what happened with the claims, OK, um, and let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII] and my number is [PII].
[AGENT][POSITIVE] I thank you.
[CUSTOMER][NEUTRAL] And I'm calling on behalf of my husband, he is at work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um, do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] I do. Policy number is 02474924.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] All right. May I have your date of birth for security?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the mailing address on file for verification?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] He has several. Let me find a sticky note.
[CUSTOMER][NEUTRAL] The first one would be [PII], and then there's [PII] other dates.
[CUSTOMER][NEUTRAL] All around the same time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What are the other dates?
[CUSTOMER][NEUTRAL] Uh, the [PII] [PII], [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, so the [PII] and then from there, we have the [PII], [PII], and [PII].
[CUSTOMER][NEUTRAL] [PII], [PII] and [PII], yes.
[AGENT][NEUTRAL] OK. Any of these, are these, like any of these are arranged dates, like all together or they're just all separate days?
[CUSTOMER][NEUTRAL] They're all separate dates. These are the do the um.
[CUSTOMER][NEUTRAL] Heart surgeon coming in to visit him each day, each of those days, uh, for his surgery, regarding his surgery.
[CUSTOMER][NEUTRAL] So they were different, yeah, so they were.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me, I'm just checking the history.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bear with me just a second. I'm gonna go ahead and pull one of the explanation of benefits, which I think they're all denied for the same reason, but let me just go ahead and check on this one.
[CUSTOMER][NEUTRAL] Yeah, I think they were too um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm still waiting on the documents.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. Um, so the the reason is that the policy does uh does not have a benefit for a doctor for an inpatient visit.
[AGENT][NEUTRAL] So it's a non-cover service.
[CUSTOMER][NEUTRAL] OK, so no doctor inpatient visits, that's odd. Um, is there, is there a different way to file it? um.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, not with us because there is no, uh, no benefit for that type of service. Um, this is a limited hospital indemnity policy, so it is limited on what is covered and that's a non-covered service. Um, now, I'm not sure if you have any other policies out there that you might want to just send it out to them and see if they cover, but with this one, it's just a non-covered.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so possibly, OK, so possibly um.
[CUSTOMER][NEUTRAL] Well that's preventative.
[CUSTOMER][NEUTRAL] OK, um, let's, I will call them back and see if they can file it with just the medical side instead of the hospital and see if that will work.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[AGENT][NEUTRAL] Well, I don't know if they have, I don't know if you have any other medical. I know this one is the one that they um that you have through him, through his employer, but this is a hospital indemnity which is medical. It's just a limited policy. It's not a major medical, um, yeah, and I'm not sure if he has any other policies out there because we're not gonna be able to see that. We only see the ones that we offer and this is the one that we have for him and it's not covered, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, that answers that question and um OK, all right, thank you so much. I appreciate your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, not that I can think of.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][POSITIVE] Thank you.