AccountId: 011433970860
ContactId: e9e616e5-7cb4-495f-84aa-263c428f497f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441980 ms
Total Talk Time (AGENT): 146882 ms
Total Talk Time (CUSTOMER): 187754 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/e9e616e5-7cb4-495f-84aa-263c428f497f_20250428T15:00_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I have a couple of questions about my
[CUSTOMER][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] Or insurance? I don't know what it is.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Do you have a, a, a policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's um.
[CUSTOMER][NEUTRAL] Uh, well, on the card, it says group number. Is that OK?
[AGENT][NEUTRAL] Um, it should be a policy slash certificate number.
[AGENT][NEUTRAL] In the bottom left hand corner.
[CUSTOMER][NEUTRAL] There's a payer ID and an in-hospital cert number and an outpatient number and a group number.
[AGENT][NEUTRAL] Um, the inpatient or outpatient number will be fine.
[CUSTOMER][NEUTRAL] 02317115 ML 7
[AGENT][NEUTRAL] OK. And what was your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then what is the address on the account?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. And in case we're disconnected, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And are you wanting to check on something for yourself?
[CUSTOMER][NEUTRAL] Yeah, I was just very surprised that the doctor just asked me for thousands of dollars and then they said,
[CUSTOMER][NEUTRAL] I don't know this is through my husband and I just called him at his office and he said to call you so I don't know um.
[CUSTOMER][NEUTRAL] They gave me some
[CUSTOMER][NEUTRAL] CPT numbers.
[CUSTOMER][NEUTRAL] And she said, I don't know what that means. I think what you, what she runs them through on the screen at the Cleveland Clinic to see what you're responsible for.
[CUSTOMER][NEUTRAL] And she said that APL isn't picking up most of it and I just wanted to know why.
[AGENT][NEUTRAL] OK. What date of service were you seeing?
[CUSTOMER][NEUTRAL] Well, I have upcoming appointments for like a CT scan on my sinuses, for instance, and they want $922.
[AGENT][NEUTRAL] So is there, is there a specific claim you're wanting to check on though that you said you got a bill for?
[CUSTOMER][NEUTRAL] Well, they handed it to me today and said you need to pay this before your appointment.
[CUSTOMER][NEUTRAL] Um, so I just wanted to make sure with you that that like that what they were telling me was right.
[AGENT][NEUTRAL] So, the bill that they gave you.
[CUSTOMER][NEUTRAL] So I didn't do the work yet.
[AGENT][NEUTRAL] OK, so they're trying to bill you for something you haven't had done yet or is this for something that you had done in the past?
[CUSTOMER][NEUTRAL] That I have not had done yet. No, I said um I rescheduled the appointment and I wanted to call the insurance to make sure this was right because they were asking me for.
[CUSTOMER][NEUTRAL] You know, usually I'm not asked for any money, really, but so I was surprised.
[AGENT][NEUTRAL] OK. Is the CAT scan gonna be done in the hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you know if they called to verify? Well, let me see if I have any notes. Let's see if anybody called to verify your benefits.
[CUSTOMER][NEUTRAL] They kind of run it through their machines at the Cleveland Clinic. I don't know like if she pulls it all up and will tell me right then and there she doesn't like call anybody, but I don't know.
[CUSTOMER][NEUTRAL] I have like a reference number and a um like a number of the code she said they used for the insurance.
[AGENT][NEUTRAL] Are you talking with a specific person at the hospital? Do you have their name?
[CUSTOMER][NEUTRAL] Uh, it was just the checkout woman at, uh, my appointment today, which was with the sinus doctor at the Cleveland Clinic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, I don't.
[CUSTOMER][NEUTRAL] So no, I don't know her name.
[AGENT][NEUTRAL] So [PII] has called with the provider's office for your eligibility date, um, and some claim status, but that was from [PII] that she was checking on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I don't know if they, I, I can't tell if they verified your employer uh employment. I can't tell if they verified your benefits, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Because you know your benefits, you have a $2500 per covered person per calendar year benefit.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, and that's after your major medical policy processes the claim, um, your primary insurance.
[AGENT][NEUTRAL] So, I'm not sure, um.
[AGENT][NEUTRAL] I mean, we would quote that that's what the benefit is. Um, let me see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Just making sure that diagnostic covers CT scans. I
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it, it should, that should be covered under that benefit. So I'm not sure.
[AGENT][NEUTRAL] Like I said, we would verify that you have a $2500 account or your benefit, that's after your primary insurance processes the claim, um.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yeah, see, this is weird. I don't know what to do.
[AGENT][NEUTRAL] Um, I would call them and see if they, do they mind giving us a call to verify the benefits that way we can explain to them, you know, exactly the dollar amount, and I don't show you've used anything this year, um, so you have that full $2500 available.
[CUSTOMER][NEGATIVE] Yeah and they're asking for less so that's see, I knew something wasn't right, um.
[CUSTOMER][NEUTRAL] OK, so then, uh, let me, um.
[CUSTOMER][NEUTRAL] So I should call the office back and tell them.
[CUSTOMER][NEUTRAL] They should call APL directly.
[AGENT][NEUTRAL] Yes, to verify your.
[CUSTOMER][NEGATIVE] Because what I was quoted probably wasn't right. OK.
[AGENT][NEUTRAL] Yeah, to verify your benefits, um, they should call us directly, yeah.
[CUSTOMER][NEUTRAL] She was just doing it through the machine, so I don't know. OK, I'll call there and then.
[AGENT][NEUTRAL] Yeah, I'm not sure either.
[CUSTOMER][NEUTRAL] Right? I don't know. She was just running it through, like on her screen and she knew everything about me that way, and APL and said no, but maybe that's why they didn't do it, right? Cause they have to call. I don't know.
[CUSTOMER][NEUTRAL] Um, I'll do that then and just give them the number and say that I was told something different, so let's just try it this way.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll do that. Thank you very much.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.