AccountId: 011433970860
ContactId: ad6cc3d3-3af3-4d4e-b9c6-85fcd186a6f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424709 ms
Total Talk Time (AGENT): 87715 ms
Total Talk Time (CUSTOMER): 283672 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/ad6cc3d3-3af3-4d4e-b9c6-85fcd186a6f0_20250610T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from the care team. Um, I have a [PII] on the line, uh, policy number.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 32.
[CUSTOMER][NEUTRAL] 93.
[CUSTOMER][NEUTRAL] 91.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she has some questions about her claim that I'm not able to answer um the claim number is, uh, do you have it pulled up? I don't wanna bark it at you.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, it's [PII], and it's the claim number ending in 4060.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the question?
[CUSTOMER][NEUTRAL] It sounds
[CUSTOMER][NEUTRAL] It sounds to me like, so she's wondering why it got denied instead of because it was a surgery, they billed it as a surgery, I guess, um, because she had some
[CUSTOMER][NEUTRAL] Something on her skin burned off and they coded it as a surgery and then it got uh denied here and she was told that if her insurance helped pay for it, it would help go towards her deductible um and I read her outpatient benefits to her that the surgery is supposed to be in an outpatient facility or free standing outpatient surgery center and she's, she's wanting to um get more research into that.
[AGENT][NEUTRAL] OK, so like it was done in our office and she doesn't have benefits to cover anything in the doctor's office, but you can send her over.
[CUSTOMER][NEUTRAL] Yeah, and that's what I said. Yeah, that's what I said and it's, she said it wasn't cosmetic, but when, when you, when she um.
[CUSTOMER][NEUTRAL] Describes it. It sounds like it was cosmetic. They didn't burn skin tags off to get them diagnosed for anything. They just took them off of her. She said it was preventative. It, it sounds cosmetic to me, but I don't want to jump to conclusions when I can't read everything that she has.
[AGENT][NEUTRAL] OK, alright, you can send her on over.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, and I will introduce you and your name is [PII], right?
[AGENT][POSITIVE] Um, that's correct
[CUSTOMER][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Alright [PII]?
[CUSTOMER][POSITIVE] Yes ma'am, I have [PII] from claim support on the line. She'll be able to help you um further with that claim, OK?
[CUSTOMER][POSITIVE] All right, thank you so much, thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII], and how can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], yes, I'm calling regarding a um something that was denied.
[CUSTOMER][NEGATIVE] Um, now the young lady that I was just speaking to, she said that it was denied because it was.
[CUSTOMER][NEGATIVE] Um, done in an in office setting. It, it needs to be done in a surgical center or something. All this was was they burnt off or froze a few spots for precautionary measures at a dermatologist. It wasn't, they didn't cut, they didn't send anything in. It was just a simple.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, like I said, like, you know, you get your skin tags burn off or whatever. I don't understand why I would have to do that in an office set. I mean, I go anywhere other than the doctor's office.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] And I, I think really I'm sorry, I think it's because the way they build it, the code they used.
[AGENT][NEUTRAL] OK. And so where were, uh, this was done in the doctor's office, is that correct?
[CUSTOMER][NEUTRAL] It was, yes, at Waters Edge dermatology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and so um maybe what she was trying to explain was that your policy only covers inpatient and outpatient services uh your policy does not provide benefits for any services performed in the doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, that's not, that's not true. I've done this many a time I've had this policy for I don't know how many years.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But every uh this policy that I have covers um it actually covers anything that's usually applied to my deductible as long as my primary insurance covers it um then APL picks up anything that's applied to my deductible.
[AGENT][NEUTRAL] But that's only if it's uh done in an inpatient or outpatient facility, not in a doctor's office.
[CUSTOMER][NEUTRAL] What's considered an outpatient facility, I mean.
[AGENT][NEUTRAL] That would be uh hospitals.
[CUSTOMER][POSITIVE] I've, I've never had this before and I've never I've done this before. If you look back, I've done this before with another dermatologist and there was never any issue.
[AGENT][NEGATIVE] I do not see anything that we have paid it that was performed in a doctor's office.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] And it's been, it's been a while back, but yes, it was with Doctor [PII].
[CUSTOMER][NEUTRAL] The exact same thing.
[AGENT][NEUTRAL] Do you have a date of service?
[AGENT][NEUTRAL] A possible data service, OK.
[CUSTOMER][NEUTRAL] I don't know. I'd have to look back and find out now, but I, I mean this like I said this.
[AGENT][NEUTRAL] Let me see if you have another policy with us.
[CUSTOMER][NEUTRAL] No, I don't. Uh, this is the only one I've ever had since.
[CUSTOMER][NEUTRAL] Probably [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am not seeing that we have paid anything in the doctor's office.
[CUSTOMER][NEGATIVE] What do you mean you've never, I mean I have stuff right here that's been paid.
[AGENT][NEUTRAL] But it would depend on where the services were performed.
[CUSTOMER][NEUTRAL] Oh, that was page, yeah, that was in, right, I'm gonna have to go and look through because the only thing I have here is just from the eye doctor, um, which was covered.
[AGENT][NEUTRAL] It was covered by American Public Life APL.
[CUSTOMER][NEUTRAL] And then this one, yes, I've never had this issue before. Um, actually, what I can do is I'll call the, I'm gonna just call the agent because I'm, I'm telling you, I was told anything that goes towards deductible it covers. I've never heard anything about office visits or anything like that. They don't cover anything.
[AGENT][NEUTRAL] And can I get that data service?
[CUSTOMER][POSITIVE] That is a co-pay. I know that, but anything else they've covered over the years I've never had to pay anything more.
[CUSTOMER][NEUTRAL] And my copay.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So let me just give them a call and see if anything's changed or you know what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, anything else I can help you with on today?
[CUSTOMER][POSITIVE] All right. Well, thank you very much, Ms. [PII]. No, ma'am. Thank you.
[AGENT][POSITIVE] You have a great rest of your day and thanks for calling APO bye bye.
[CUSTOMER][POSITIVE] You too thank you mhm bye bye.