AccountId: 011433970860
ContactId: 900fb7d8-33d7-4503-84d5-c8235ab53c5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557659 ms
Total Talk Time (AGENT): 182727 ms
Total Talk Time (CUSTOMER): 227533 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/900fb7d8-33d7-4503-84d5-c8235ab53c5a_20250505T21:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Yeah, I got a couple of questions. I, um, I have I fractured my ankle, uh, and I submitted a claim and I did get a payment, but I don't understand why it says it's been met and I didn't get anything for a couple of the things that I submitted and it closed it and my thing was met before I ever got, you know, I'm still seen by the doctor. Mm.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 025-07767.
[AGENT][NEUTRAL] And can I get your name and your date of birth?
[CUSTOMER][NEUTRAL] My name is [PII] and my date of birth is [PII]. I was about to, like I'm typing it.
[AGENT][NEUTRAL] OK, just gonna verify a few pieces of information. What is your address?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Yeah, one minute. [PII]. I'm not crazy. I'm just tired.
[AGENT][NEUTRAL] Yeah, I understand. um, and then your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And then Ms. [PII], could I get a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me look up on your policy and see what we have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah I was looking at the explanation I've been, go ahead.
[AGENT][NEUTRAL] Uh, you got the payment for 2100, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, pull up your policy.
[CUSTOMER][POSITIVE] And I actually submitted some more.
[CUSTOMER][NEGATIVE] Uploaded some more itemized bills because I'm still being seen by the doctor. And, and when I looked on my, the booklet, it doesn't say a maximum like the amount of X-rays and it doesn't say, it's just like 6 visits I thought.
[AGENT][NEUTRAL] OK, let me see what's going on.
[AGENT][NEUTRAL] OK, I'm pulling up your policy. Just bear with me. Give me one moment.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] Uh, the initial treatment, did you go through the ER?
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEGATIVE] And then it, it's, it's paid for that, paid for X-ray there, but it didn't pay the X-ray for the orthopedic that I went to, which is [PII] X-ray, didn't pay nothing for that one.
[CUSTOMER][NEUTRAL] And then I've had a couple of more X-rays. She she X-rays it.
[CUSTOMER][NEUTRAL] Again, I, I, I actually, she actually, I sent another um I downloaded a um
[CUSTOMER][NEUTRAL] A picture of the bill.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] With the codes on it.
[CUSTOMER][NEUTRAL] But if you get down to the bottom of it, cause I'm looking at an explanation, it says it's something in there and I was like, why? Because
[CUSTOMER][NEUTRAL] I'm not done. I still got, I still got a brace on my foot.
[AGENT][NEUTRAL] So it's like.
[AGENT][NEUTRAL] So according to this policy, so emergency treatment benefits.
[AGENT][NEUTRAL] So, under that emergency treatment benefit, it lists the initial treatment, which was 600, physician's office 200.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] X-ray is 100. And again, this is part of the emergency room benefits.
[AGENT][NEUTRAL] So that's, that's the max in the ER is the 100.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, after that, um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's certain payable amounts for, are you having surgery?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] There's payable amounts for surgery, um, for certain fractures.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Transportation. Yeah, so it looks like the $100 that paid the $100 because that was part of the ER visit. So that's the max that we'll pay for the ER visit.
[CUSTOMER][NEUTRAL] OK. What about the, the follow-up visits? How many do I supposed to get on that? Because I see, I mean, it, it doesn't cover any, no more of them?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Follow-up treatment
[CUSTOMER][NEUTRAL] I see 2, but.
[AGENT][NEUTRAL] Yeah, so follow-up treatment benefit is it pays $100 for a maximum of 6.
[AGENT][NEUTRAL] Following the visit or following the accident.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so I see that it's paid for 2 and I've submitted more. Well, but will it still.
[CUSTOMER][NEUTRAL] Will it still pay?
[AGENT][NEUTRAL] Yeah, so it would pay up to that 6. So let me see, you've got.
[AGENT][NEUTRAL] One follow-up visit on here on [PII]. Let me see what else we got. 324, so that's 2.
[AGENT][NEUTRAL] So you've only used 2 so far that we've paid on, so you'd have 4 left that we would pay on.
[AGENT][NEUTRAL] $100
[CUSTOMER][NEUTRAL] OK. Can you, can you see, what about the X-rays? Is it up for the, the X-rays is maxed out or what? But she's X-raying it every darn time she, I go.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, correct. Yeah. So the X-ray benefits only in the ER and it paid $100.
[AGENT][NEUTRAL] So after that, it's just a straight 100, no matter what they charge for, for your follow-up visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I mean, I submitted some more uh documents. Can, can you see that or you, you can't, did I submit the right documents because I, I, they sent me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] To modernized bills and I, I submitted that, well, I submit that.
[CUSTOMER][NEGATIVE] I don't know if I did it right. Maybe I need to go back and if I didn't do it right, I need to do something else.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, let me see. I've got, we have received something it looks like it's in processing. um, let me see what we got.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, it looks like we've got one for 4:25.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] Yeah, so, so we've got the follow up from [PII], we've got the follow up from.
[AGENT][NEUTRAL] 324 that we already paid and then this what's in processing looks like we've got your follow up for 425.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm trying to see the other one, yeah, 425, yeah, so that's in processing right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so when I have to, I have to go back on the [PII], so I'll need to send that one in again, right? Just keep, just send it again and again, OK.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's what I, that was my, that was it because what I was kind of confused about the X-ray. Did it pay for the visit and the X-ray, but it doesn't. It just pays the $100. OK.
[AGENT][POSITIVE] That's correct, yeah.
[CUSTOMER][NEUTRAL] OK, that's what I was, that's what I wanted to know. So and I will, like I say, when I go back on the [PII] and I get that out of my bill, I'll submit it too. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And that'll be up to 6. So hopefully I won't have to go back after the next one. I, I'm, I'm crossing my fingers that I don't have to go back after the next one.
[AGENT][POSITIVE] Yes, I'll cross it with you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, you know, it, I won't, I want the benefit for having the insurance, but I really want this to be over with too.
[AGENT][POSITIVE] I totally understand, totally understand.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for your help.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a good evening.
[CUSTOMER][NEUTRAL] You too bye bye.