AccountId: 011433970860
ContactId: 9eecf85c-a32b-4b03-b881-f111d427eac6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381820 ms
Total Talk Time (AGENT): 193298 ms
Total Talk Time (CUSTOMER): 98531 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/9eecf85c-a32b-4b03-b881-f111d427eac6_20250611T17:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes my name is [PII], and I just want to see how much y'all have paid on of my any of my bills.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] It is 01677928.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] My uh birthday is [PII].
[CUSTOMER][NEUTRAL] And my mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So you'd like me to go through the claims that we've processed and let you know the total of the ones we've paid out on?
[CUSTOMER][NEUTRAL] Just to do you just have a total how much you paid?
[AGENT][NEUTRAL] Like for this year, um, hold on one moment.
[CUSTOMER][NEUTRAL] This year
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for this year so far, we've paid $384.31.
[CUSTOMER][NEUTRAL] OK, can you kinda give me an idea of what y'all pay on?
[AGENT][NEUTRAL] Mhm, like your coverage or what this paid out to?
[CUSTOMER][NEUTRAL] No, just like if I go to the doctor today.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] What you know, kind of what y'all pay on because.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I, I've been getting these papers saying 0000.
[AGENT][NEUTRAL] OK, let me take a look. Hold on one moment. I'm pulling up your benefits now. And just for the call again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] OK, so the policy is broken down into in-hospital and outpatient. So inhospital is anything, anytime you're admitted into the hospital, all those charges, um, we would pay up to $1000 per calendar year.
[AGENT][NEUTRAL] And the same for outpatient, um, we would pay up to $1000 per calendar year. Outpatient is the um emergency room, urgent care, um, outpatient surgeries, uh, physical therapy facilities.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, also, because you have the office treatment writer, any treatment done in the physician or specialist office, the office setting, um, would be covered up to that $1000 per calendar year.
[CUSTOMER][NEUTRAL] OK, like
[CUSTOMER][NEUTRAL] OK, like if I'll go to my back doctor and they give me a steroid shot, is that covered?
[CUSTOMER][NEUTRAL] Or no.
[AGENT][NEUTRAL] So the only way to guarantee it is to see the codes when we process it, but based on your, your coverage, the office treatment rider, as long as it's not cosmetic, it should be covered under that office treatment rider up to the $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I've been getting these papers, I'm saying 0.
[CUSTOMER][NEGATIVE] 000 y'all are not paying that.
[AGENT][NEUTRAL] So what, um, let me see, like these office probably, OK.
[AGENT][NEUTRAL] So the treatment, that's why I was specifying the treatment. So basically, these charges here like um it's one of the ones you have there 3607363?
[CUSTOMER][NEUTRAL] The what now?
[AGENT][NEUTRAL] Of the claims that you're showing or the letters that you're getting with 0 being paid.
[AGENT][NEUTRAL] So I was asking about one of the claim numbers, but basically this is saying office visits are not covered. The treatment in the office is covered. What, but what they're billing for is the facility, like the place of service.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So that's what the difference is there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Like if I go to the.
[CUSTOMER][NEUTRAL] Foot doctor.
[CUSTOMER][NEUTRAL] And he gives me shots that should be covered.
[AGENT][NEUTRAL] The shot would be should be covered under the office treatment rider, but if they're billing for the in the office, like the place of service is an office or like an outpatient facility, if they're charging for the place of service, which is what this is, it will not be covered because
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you didn't have this rider added to your policy, it wouldn't have any coverage for the physician, specialist for any in-office, but because you have the rider.
[AGENT][NEUTRAL] That's what's covering the treatment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I still don't understand it, but I'll I'll try to figure it out more.
[CUSTOMER][NEUTRAL] Cause I give them all, all of it to, you know, I give it to everybody I go to.
[CUSTOMER][NEUTRAL] And it seems like
[CUSTOMER][NEGATIVE] Should be paid more than $300 but.
[CUSTOMER][NEUTRAL] 3 I didn't have to pay, I guess.
[AGENT][NEUTRAL] I