AccountId: 011433970860
ContactId: d47f15c1-71e7-4846-8784-3fa422c6e934
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276380 ms
Total Talk Time (AGENT): 139527 ms
Total Talk Time (CUSTOMER): 113805 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/d47f15c1-71e7-4846-8784-3fa422c6e934_20250117T17:07_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I got a bill from my doctor. It's saying that um I got denied from the APL to, to help with the uh payment of the bill.
[AGENT][POSITIVE] Well, I would be happy to check that for you, sir. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I have the card in front of me which says uh my my name the group I group number and uh.
[CUSTOMER][NEUTRAL] Stuff like that
[AGENT][NEUTRAL] Yes, sir, if you can have that policy certificate number.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The group number you mean?
[AGENT][NEUTRAL] No sir it's gonna be a policy certificate number. It could be at the bottom of the card under the outpatient or inpatient.
[CUSTOMER][NEUTRAL] Oh, I, oh, I, uh, you're right. Did you, uh, I was out, outpatient, I guess, right? Because I just visited them. I didn't stay in the hospital. OK, thanks. It's uh 025419997 M like.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, it
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like May and L like Lima and the number 8.
[AGENT][NEUTRAL] All right, thank you, sir. Do you mind verifying your name and date of birth please?
[CUSTOMER][NEUTRAL] [PII], I, I was born [PII].
[AGENT][NEUTRAL] All right. And what is your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, my mobile number [PII].
[AGENT][NEUTRAL] And I do have an iCloud email on file for you. Can you verify that also?
[CUSTOMER][NEUTRAL] Yes, it's my first name and my last initial, so [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. Thank you, Mr. [PII].
[AGENT][NEUTRAL] Now I do have a claim on file for you for data service 1021 24 for an.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A doctor who saw me.
[CUSTOMER][NEUTRAL] That's correct, that's the one I'm calling about.
[AGENT][NEUTRAL] OK, so they did send us a claim and it was denied. Now your policy does not cover office visits, and that's what they charged for so it would not cover your office visit co-pay.
[AGENT][NEGATIVE] So it was denied.
[CUSTOMER][NEUTRAL] I thought that's
[CUSTOMER][NEUTRAL] What is the secondary insurance supposed to cover then if, I mean you always go to a doctor, it's always an office visit so that that's very weird to me because you always go to a doctor, it's always an office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Now, your policy does not cover any services performed in a doctor's office. It is going to cover things like hospitalization.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It'll cover emergency rooms, urgent care.
[AGENT][NEUTRAL] Outpatient surgery.
[AGENT][NEUTRAL] Um, physical therapy.
[AGENT][NEUTRAL] A diagnostic testing in an outpatient facility.
[AGENT][NEUTRAL] It also covers independent laboratories.
[AGENT][NEUTRAL] Like, you know, like quest or or Labor.
[CUSTOMER][NEUTRAL] Well, I, well, I went, I went, I, he's, he's uh like a like a back doctor.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I, I went to, I went to him and they did, uh, like, uh, what do you call like X-ray.
[CUSTOMER][NEUTRAL] Because you know, so I.
[CUSTOMER][NEUTRAL] I started getting uh like swelling, so I thought that.
[CUSTOMER][NEUTRAL] I thought it was covered, but uh.
[AGENT][NEUTRAL] Yeah, it would not be covered in a doctor's office.
[AGENT][NEUTRAL] Now, if he, if you went to him and then he sent you to a diagnostic center or an outpatient hospital for to do the X-rays, then it could be considered for benefits because it was performed in a covered facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, because they got a big bill here for like $139. I, I don't make that much money. So alright, thank you. I thank you.
[AGENT][NEUTRAL] Yeah, that is a lot. And then I'm, I'm sorry your policy doesn't cover it, but it's just a non-covered benefit under your plan. Now we do have a portal. If you're ever interested, you can create a login and password. It should be on your card and you can click on your policy number and it will show you the benefits covered.
[CUSTOMER][POSITIVE] Oh, no problem.
[AGENT][NEUTRAL] According to the guidelines of your policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] All right, thanks for explaining. You have a great day. Thank you for your time.
[AGENT][POSITIVE] And thank you for calling APL Mr. [PII]. Thank you. You have a wonderful day and a happy weekend.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.