AccountId: 011433970860
ContactId: 98ff41e3-7e08-467b-81b7-ea0acaa31913
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 673200 ms
Total Talk Time (AGENT): 273988 ms
Total Talk Time (CUSTOMER): 146517 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/98ff41e3-7e08-467b-81b7-ea0acaa31913_20250331T21:32_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, I got uh.
[CUSTOMER][NEUTRAL] The letters in the mail. One was a um.
[CUSTOMER][NEUTRAL] Letter just saying that you guys were processing everything and the other one is saying it had two different notifications on.
[CUSTOMER][NEGATIVE] One of them said that you needed an itemized statement and then underneath it it said that it's not a guaranteed or it's not covered or payable but it doesn't tell me what which claim.
[CUSTOMER][NEUTRAL] Like I don't know which one is this.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Um, it's 0254727.
[AGENT][NEUTRAL] But.
[AGENT][NEUTRAL] I think I might have missed a number. Let's try that again. Hold on one moment, let me get that pulled back up. OK, what was the number again?
[CUSTOMER][NEUTRAL] The policy number is 025472227.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was your name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I just need to verify a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And email.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's see what we have here um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like I just have one claim um let's see.
[CUSTOMER][NEUTRAL] Well, it looks like they might have put them all on one, but there's like no totals. I don't know which one's which like.
[CUSTOMER][NEGATIVE] Um, it's saying like information requested, information requested, and non-coverage, non-coverage. Like I don't know why they wouldn't be covered.
[AGENT][NEUTRAL] OK, let me see, let me pull up what we received, see what's going on.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, got your.
[AGENT][NEUTRAL] Let's
[AGENT][NEUTRAL] OK, it looks like we received um the claim submission for there was an office visit for 364. I see that.
[AGENT][NEUTRAL] Um, let's see what else we have.
[AGENT][NEUTRAL] It looks like we got quite a few pages.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 42 different pages. OK, um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you have a hospital indemnity plan, um.
[AGENT][NEUTRAL] It's gonna pay for obviously certain things you've got hospital admission. Was this, uh, I know there's 40 something pages. So did you submit like, were you admitted to the hospital? Did you have a hospital confinement? Is this a lot of physician offices or a combination of things?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I went to the doctor because I was having severe hip pain. And they said, well, I, the one visit was for UTI. And then I went to my doctor, they tested me and everything and sent me for urine cultures and stuff. And then the other time I went to a, um, from my rheumatologist for my hip, I was under no awareness that this was a discount plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, also, just so you know, um, I could have gotten a regular insurance plan for the same price I'm paying for this. And obviously, you guys aren't paying anything. And I could have done, I could have got a better discount myself. Like there's no, there was no purpose in having this.
[CUSTOMER][NEGATIVE] I was completely misled that that's what this plan was.
[AGENT][POSITIVE] OK, um, so sorry about that. Let's see what's.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, cause what it pays for is hospital admission, hospital confinement, um, emergency room, urgent care, physician's office.
[AGENT][NEUTRAL] And then physical speech and occupational therapy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That that's basically.
[AGENT][NEUTRAL] What all the services encompass is what it would pay for. So anything kind of outside of that uh scope.
[AGENT][NEGATIVE] is denied, which would be why there's several on here that are denied.
[AGENT][NEGATIVE] Looks like there's lab work um that was denied.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The office visit, let me see why that didn't.
[AGENT][NEUTRAL] Process
[AGENT][NEUTRAL] So the office visit.
[AGENT][NEUTRAL] I, I see the $364 charge.
[AGENT][NEUTRAL] But it doesn't show a
[AGENT][NEUTRAL] Diagnosis.
[AGENT][NEGATIVE] Looks like that's the problem on the office visit.
[AGENT][NEUTRAL] So that that would potentially pay if we received the diagnosis for that office visit that was for data service.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] With doctor.
[AGENT][NEUTRAL] And this is for doctor.
[AGENT][NEUTRAL] Allegheny Health Network.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, that's my rheumatologist.
[AGENT][NEUTRAL] OK, [PII] was the date of service.
[CUSTOMER][NEUTRAL] Are you sure there's no diagnosis on there?
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] I didn't see it on that actual the itemized that has that code.
[AGENT][NEUTRAL] OK, I do see, let's see, for the same date they did.
[AGENT][NEUTRAL] Like X-rays.
[AGENT][NEUTRAL] trying to make sure nothing was missed.
[AGENT][NEUTRAL] I see the lab work that was for 9:27.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Sorry, I'm just having to scroll through. Sorry, it's taking so long.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I appreciate you looking.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 9:30. I see 9:30. There were several lab charges.
[AGENT][NEUTRAL] I don't think there's a diagnosis for that office visit. OK, more lab charges.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see it there.
[AGENT][NEUTRAL] OK, more lab charges that was for 9:27.
[AGENT][NEUTRAL] OK, we're getting close to the bottom just a second.
[AGENT][NEUTRAL] OK, there's that office visit again. OK, that was 9:27, looks like for a doctor.
[AGENT][NEUTRAL] Or medical bill or price or was.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] There's a doctor's visit.
[CUSTOMER][POSITIVE] Yeah, that would be my family dog.
[AGENT][NEUTRAL] Yeah, 9:27, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 27
[AGENT][NEUTRAL] OK. No, I did look through everything and I don't see a diagnosis.
[CUSTOMER][NEUTRAL] You need a diagnosis for both appointments?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Looks like it we do.
[CUSTOMER][NEUTRAL] Um, how can
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Is that something I can just send to you? How do I get it to you?
[AGENT][NEUTRAL] Um, you can fax it, uh, that would be fine. Um, do you have our fax number or would you like me to give that to you?
[CUSTOMER][NEUTRAL] Uh, you can give it to me, hold on.
[AGENT][NEUTRAL] And you just wanna like maybe print so it have to be documentation from the providers so there could be like, I don't know if you have like an online portal with your doctor that you could um.
[AGENT][NEUTRAL] Print it off from or take a.
[AGENT][NEUTRAL] Snapshot of or.
[AGENT][NEUTRAL] Or if they'll give you, provide you something.
[CUSTOMER][NEUTRAL] Mm, I can try to find
[CUSTOMER][NEUTRAL] Yeah, I'll try to find out. I don't know what I'll be able to find, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] nothing's ever easy for sure. OK, go ahead.
[AGENT][NEUTRAL] And the fax number is [PII].
[CUSTOMER][NEGATIVE] OK, and do you, can you even tell me how much that they would even pay before I waste my time going through this back and forth because I've sent these bills in like multiple.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah, so the, so for physician's office, it's gonna pay $50.
[AGENT][NEUTRAL] Per day, up to a max of 3 days per calendar year. So pay 50 and 50 if you have the 9:30 and then the 927, so pay 100 total, and that's not a guarantee of payment it's a basic outline of your policy.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's all.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good evening.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][NEUTRAL] Bye.