AccountId: 011433970860
ContactId: d33d5363-1ff6-40a4-bcd4-2598725c4975
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231889 ms
Total Talk Time (AGENT): 82332 ms
Total Talk Time (CUSTOMER): 91124 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/d33d5363-1ff6-40a4-bcd4-2598725c4975_20250227T20:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII] [PII]. I wanted to check to see if I'm covered on something.
[AGENT][NEUTRAL] I'll be happy to verify coverage. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, 01826050.
[AGENT][POSITIVE] May I have a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email?
[CUSTOMER][NEUTRAL] Yes, [PII] and the address is [PII] and the email is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. OK, [PII], it looks like this plan termed on [PII], and I'm not showing any active policy.
[CUSTOMER][NEUTRAL] Well, OK, but this would have been for [PII] when I had an active policy.
[AGENT][NEUTRAL] OK, let me get that pulled up and please be advised verification of coverage does not guarantee the payment of the claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, and I have it pulled up. And how can I assist you?
[CUSTOMER][NEUTRAL] Uh, does X-rays get covered?
[AGENT][NEUTRAL] Yes, where would your place of service be outpatient?
[CUSTOMER][NEUTRAL] Yes, I went to outpatient um.
[CUSTOMER][NEGATIVE] And my insurance company didn't cover it.
[AGENT][NEUTRAL] Your primary?
[CUSTOMER][NEGATIVE] My prim my primary insurance didn't cover it.
[AGENT][NEUTRAL] This plan follows your primary, so if your primary does not pay, this plan will not pay.
[AGENT][NEUTRAL] Because it picks up.
[CUSTOMER][NEUTRAL] Yeah, but I've done it. I, I've done it before like I didn't go to a provider. I had to get it done right away, but I've had, I've sent stuff in before as long as they got an explanation of benefits from my provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They said they accept it.
[AGENT][NEUTRAL] Correct. If the explanation of benefits shows the copays, coinsurance, and our deductibles, yes, it will pick up. Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK, OK, so I have the explanation of benefits, but they just didn't pay anything on it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so yes, they'll process it and show no benefits applied or whatever the codes are based on that claim.
[CUSTOMER][NEUTRAL] Right, and what, what is that for a $25 reimbursement for that?
[AGENT][NEUTRAL] Let's see for outpatient, it allows.
[AGENT][NEUTRAL] Just wait on the system one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And I went to an X-ray center, diagnostic.
[AGENT][NEGATIVE] OK. For some reason it's just been extremely slow today.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So outpatient per occurrence allows $500 and that will be per condition.
[CUSTOMER][NEUTRAL] OK, so that would be just for X-rays at a diagnostic center.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Can you call me back?
[CUSTOMER][NEUTRAL] Please.