AccountId: 011433970860
ContactId: a644f582-c2ed-4b82-9b37-04342447d575
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600840 ms
Total Talk Time (AGENT): 157405 ms
Total Talk Time (CUSTOMER): 322291 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/2025/04/08/a644f582-c2ed-4b82-9b37-04342447d575_20250408T12:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I had a question about um a claim and if it's covered or not um.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] Let's see what do you need from me?
[CUSTOMER][NEUTRAL] This is [PII] and my last name is [PII].
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number is 2054428.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's your date of birth, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] My address is [PII] and email address is [PII].
[AGENT][NEUTRAL] That's not the email address we have.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Yes, ma'am. That's it. Thank you, Ms. [PII]. And you had a question about a claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] This was the one that was on.
[CUSTOMER][NEUTRAL] The date is [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that's fine.
[CUSTOMER][NEUTRAL] So it paid out $120.
[CUSTOMER][NEUTRAL] But my question is, the procedure that I had, I had to pay a deductible that was $1500 and that was paid out, um, but there was an additional fee from the doctor that was, um, that the insurance did not cover, and I'm trying to find it here in these, um, PDF, but I think it mentioned that.
[CUSTOMER][NEGATIVE] It it was denied I guess because insurance already paid but the insurance didn't pay it.
[AGENT][NEUTRAL] OK, hold on, let me look at it for you.
[CUSTOMER][NEUTRAL] Um, I had to pay that out of my pocket, mhm, OK.
[CUSTOMER][NEUTRAL] I'm trying to see which one.
[AGENT][NEUTRAL] And that day the service was [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, um, that was the one that was paid out um.
[CUSTOMER][NEUTRAL] It's kind of confusing. Let's see here.
[AGENT][NEUTRAL] OK, which one was denied?
[CUSTOMER][NEUTRAL] Uh, let me pull it up here
[CUSTOMER][NEUTRAL] I figure it out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and my computer is trying to load this PDF.
[AGENT][NEUTRAL] That's fine. I, I can wait.
[AGENT][NEUTRAL] Was it a facility bill, like, um.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] In February for February?
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] We have several things.
[CUSTOMER][NEUTRAL] Yeah, so on this um explanation of benefits, it just came up, um, I'm not sure because I had surgery and so what's listed here.
[CUSTOMER][NEUTRAL] My surgery was on [PII], and it says treatment physician's office, but that treatment was in the hospital, um.
[AGENT][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] By [PII] and so I think that was like $800 and some odd dollars. The insurance paid some on it, but it was an $800 and something dollars bill. So that's actually what I question, not the doctor's office visits because I know that's not covered, but that fee, that $800 and something dollars that was on that original bill was the charge from the doctor from the surgery that I had in the hospital.
[CUSTOMER][NEUTRAL] And it just happened to be part of that big $1200 but I just wanted to show like I did pay it.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And um to reference, let me see here if I can get to the actual.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Does it tell you a data service on it or?
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] A claim number, does it tell you a claim number or data service? the one?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] There's one in here that has.
[CUSTOMER][NEGATIVE] Nothing, it's like a, a document that I uploaded, um, it doesn't have anything attached to it, but that's the document that I am referencing the $800 and something dollars for the surgery. Um, it doesn't have anything attached to it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The claim number that has that.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] It's confusing because
[AGENT][NEUTRAL] We do have some mail in that hasn't been processed. Is that the one you're talking about?
[CUSTOMER][NEUTRAL] They attached this 120.
[CUSTOMER][NEUTRAL] Well, I uploaded the documents again because um I did that this morning, so those are the same documents I uploaded that they didn't say it was denied, they just gave me $120 for that $1200 bill, but it's a hospital part on that bill too that needs to be paid, I think, um.
[CUSTOMER][NEUTRAL] I mean, and there's
[AGENT][NEUTRAL] I do, I do have a claim for 23 2025 that.
[AGENT][NEUTRAL] Hold on, let me look at it.
[AGENT][NEUTRAL] Let me see what I always say.
[CUSTOMER][NEUTRAL] So, yeah, that one was.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let's see uh.
[CUSTOMER][NEUTRAL] I think it's just confusing because I pretty much gave my whole medical record to get the deductible paid and then it was another bill from the actual doctor that did the surgery, but it was attached to a bill that had office visits on it. But the charge that she charged was for um.
[CUSTOMER][NEUTRAL] The surgery she did in the hospital.
[AGENT][NEUTRAL] OK. Did, did you get the check for $1,367.31 yet?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I did, I did.
[AGENT][NEUTRAL] OK, so that hand.
[CUSTOMER][NEUTRAL] Mhm, I got the 132 and I got the 120 as well. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I had the surgery for Atlanta Women's Healthcare on it.
[AGENT][NEUTRAL] For 2325, 88799.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] The 88799, that's the one.
[CUSTOMER][NEGATIVE] That I am questioning like am I entitled to compensation from that because that was out of pocket.
[AGENT][NEUTRAL] That's the one that was on the check for 1,36731.
[CUSTOMER][NEUTRAL] Um, and it was the.
[AGENT][NEUTRAL] We paid 887.99 for the surgery.
[CUSTOMER][NEUTRAL] Well, um,
[AGENT][NEUTRAL] And they had
[AGENT][NEUTRAL] It had office visit on it and it has some services done in the doctor's office for [PII] on it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, so what about?
[CUSTOMER][NEUTRAL] Well, I'm confused because I thought I was getting paid for my co-pay, which was $1500 so I paid that is what I paid $1500 and I paid another $800.
[CUSTOMER][NEUTRAL] For the surgery.
[CUSTOMER][NEUTRAL] And I, I mean, I submitted every document that's available. I gave my whole medical record the day I was in surgery, discharge doctor's notes, and then I submitted all the bills. I showed where I paid all the bills.
[CUSTOMER][NEGATIVE] I'm just and it's confusing to like what's paid and what's not paid um and I'm trying to understand it I just confusing.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. All you get is $1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] So we pay that 1500. That's the maximum, yes ma'am, per calendar year is 1500 for the outpatient and that's what we've paid out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it like a Mac?
[CUSTOMER][NEUTRAL] Oh, I didn't know that. So if I had another surgery, I wouldn't cover that like in the next month or so.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, I, I didn't know that. I didn't know it was.
[AGENT][NEUTRAL] If it's outpatient now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have an inpatient of 1500 as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But outpatient Max has already been met.
[CUSTOMER][NEUTRAL] So it, it was like.
[CUSTOMER][NEUTRAL] OK, OK, well that makes sense then cause I'm just like what else do they need? I thought um it was just covering like all my out of pocket expenses. OK, well, that's it, and I guess the other $1500 that's if I were to go into the hospital and stay in the hospital, is that what that is?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. That is if you stay in the hospital over 18 hours. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Gotcha. OK. Well, I appreciate it. That's been helpful.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, ma'am, you've been most helpful. I appreciate it.
[AGENT][POSITIVE] Thank you, Ms. [PII], for calling APL. You have a good day. If you have any more questions, give us a call back.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.