AccountId: 011433970860
ContactId: ed398f23-5455-452b-87ff-7515991bc7a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 836039 ms
Total Talk Time (AGENT): 395564 ms
Total Talk Time (CUSTOMER): 171640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/ed398f23-5455-452b-87ff-7515991bc7a8_20250331T14:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi [PII], this is [PII]. I spoke to you on Friday regarding a claim that I've been trying to get reimbursed for quite some time now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, hi, how are you?
[CUSTOMER][POSITIVE] Hi I'm good how are you?
[AGENT][POSITIVE] Good.
[CUSTOMER][NEGATIVE] It's um I refax yeah I'm calling to find out what you know I re-faxed it like I was told so far it's so far with faxing and scanning it's it's, it's cost me like almost $20 and I feel like I'm just putting more money into this and just not getting reimbursed.
[AGENT][NEUTRAL] Are you wanting
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, could you give me your policy number again, Ms. [PII]?
[CUSTOMER][NEUTRAL] Sure, of course. Uh 025.
[CUSTOMER][NEUTRAL] 919-61
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I faxed everything again for the third time on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then um.
[AGENT][NEUTRAL] What, uh, what time did you fax that?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What time was it? um.
[CUSTOMER][NEUTRAL] I'm looking for at the receipt. It just has the just has the confirmation number, the date. I don't see a time.
[CUSTOMER][NEUTRAL] I think it was around [PII]
[AGENT][NEUTRAL] OK, [PII] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, I think so. I think so. I'm not 100% sure. It doesn't say the time here.
[AGENT][NEUTRAL] And are you Eastern?
[CUSTOMER][NEUTRAL] Um, oh yeah, Eastern. I'm in [PII].
[CUSTOMER][NEUTRAL] It was 6 pages in total.
[AGENT][NEUTRAL] 6 pages, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you mind if I put you on a hold and I'm gonna check into our database and get my contact on the line, see if we've got this, OK?
[CUSTOMER][POSITIVE] Thank you so much. OK. Thank you, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Good morning. Hey, um, do you have just a moment?
[AGENT][NEUTRAL] Nope, kind of a couple of moments.
[AGENT][NEUTRAL] This is that lady that we discussed last week, uh, that you, yeah, that, um, she's got the fax date and time so I was gonna see if you can see if we received it. OK, yeah, um, when she fax it in, uh, she faxed it on [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] At around [PII] but it's Eastern time, so I'm not sure if that appears as.
[AGENT][NEUTRAL] [PII], it's an hour, they're an hour ahead, so it'd be around [PII]
[AGENT][NEUTRAL] I always get confused about times. OK, let's see, yeah, they're an hour ahead. I know that, so.
[AGENT][NEUTRAL] And she said, you said when did she send it? Uh, it was around [PII] and it's 6 pages.
[AGENT][NEUTRAL] What day? Uh, [PII].
[AGENT][NEUTRAL] 328.
[AGENT][NEUTRAL] 328.
[AGENT][NEUTRAL] And what was her name? Her name is [PII].
[AGENT][NEUTRAL] Oh, that's it.
[AGENT][NEUTRAL] I think it's so.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No, I'm not.
[AGENT][NEUTRAL] Dude, the hand is that her, the handwriting, is it [PII]?
[AGENT][NEGATIVE] Yeah. What the hell?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Or is that her? I don't know if that's her. Is that her?
[AGENT][NEUTRAL] And what's her name again? [PII].
[AGENT][NEUTRAL] No, that's not her. OK.
[AGENT][NEUTRAL] All right, let me look at
[AGENT][NEUTRAL] She couldn't give me the exact time, but she said it was, she believes around [PII]
[AGENT][NEUTRAL] You said 6 pages? Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And I specifically told her, you need to write down what time?
[AGENT][NEGATIVE] The hell, dude.
[AGENT][NEUTRAL] I would say just be careful, your phone call is being recorded. Oh, if we're on um
[AGENT][NEUTRAL] If we're on um teams.
[AGENT][NEUTRAL] So, uh, since you still have her on hold.
[AGENT][NEUTRAL] Oh, OK, OK, got it.
[AGENT][NEUTRAL] Let's let's look at the one from [PII].
[AGENT][NEUTRAL] Yeah, maybe, um.
[AGENT][NEGATIVE] And then this thing is, it, it's so slow sometimes. Yeah, no, no, thanks for checking.
[AGENT][NEGATIVE] I was hoping you would be available to check. Oh, she's gonna be really upset.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] it.
[AGENT][NEGATIVE] I know, I know, maybe this is it, 6 pages fingers crossed.
[AGENT][NEUTRAL] Came in at [PII] so OK let's see. So let's look at it and see if you don't mind, do you think it's gonna.
[AGENT][NEUTRAL] Work
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Because you used to process claims, right?
[AGENT][NEUTRAL] Yeah. So. Oh, me too, this policy.
[AGENT][NEUTRAL] 2591961.
[AGENT][NEUTRAL] Oh, it's HR OK.
[AGENT][NEUTRAL] This is the reason for the appointment illness you are on.
[AGENT][NEUTRAL] There is diagnosis, influenza, cough, nasal congestion. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, there's the CPT we got hospital.
[AGENT][NEUTRAL] So she went to an urgent care. OK.
[AGENT][NEUTRAL] For coming to hospital, yeah, flu symptoms, OK. Office visits.
[AGENT][POSITIVE] Yeah, so we received it. It has the assessment. It has a diagnosis code. OK, good deal. Has the procedure code, so good. OK.
[AGENT][NEUTRAL] Now it's just a matter of is this covered under her policy.
[AGENT][NEUTRAL] Uh, let's see or HR sorry.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Why does this not have her policy certificate?
[AGENT][NEUTRAL] Uh, see, now she has the.
[AGENT][NEUTRAL] Outpatient sickness right, she should be good to go. Let me look in the.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I look on this screen.
[AGENT][POSITIVE] Thank you for helping me. I appreciate you. No, you're welcome. Let's see. Office treatment. There it is, urgent care, so it pays like $50. OK.
[AGENT][POSITIVE] Remember to give her the uh disclaimer we can't say yes we're gonna pay $50 but per your policy you have a benefit for $50 per day for an urgent care visit. OK, OK, perfect. OK, thank you so much. Alright, you're welcome. I tell her it'll be placed in line for processing. OK, perfect. Thank you. All right, you're welcome. All right, bye. Bye.
[AGENT][POSITIVE] OK, are you there? Sorry, sorry about that.
[AGENT][NEUTRAL] OK, we did receive it, um, so it's in line for processing. Um, it looks like based on your policy, not a guarantee of payment, just a basic outline of your policy for this was an urgent care visit, is that correct?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, looks like based on the policy that you have, this will pay out $50.
[CUSTOMER][NEUTRAL] That's all?
[AGENT][POSITIVE] Yes, um, for office visits or urgent or office visits, it's a $50 benefit.
[CUSTOMER][NEUTRAL] That's not like I have on my, on my thing.
[AGENT][NEUTRAL] Now, do you have a major medical policy?
[CUSTOMER][NEUTRAL] No, I have the whatever I have whatever you, whatever you say. I don't have another policy if that's what you're asking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I didn't, I didn't realize it was only $50. I have the um.
[CUSTOMER][NEUTRAL] I was I was told.
[CUSTOMER][NEUTRAL] I have the, the PHCS and I was told that.
[CUSTOMER][NEUTRAL] You have any out of network.
[CUSTOMER][NEUTRAL] Any other network doctors I was told that I would get the.
[CUSTOMER][NEUTRAL] The full amount
[CUSTOMER][NEGATIVE] I don't know. I feel like with this policy, it's like whatever I'm told it never happened. I I have not gotten any reimbursements to date.
[CUSTOMER][NEUTRAL] On anything it says the um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A co-payment, a co-payment of $25 which I paid when I was there.
[CUSTOMER][NEGATIVE] And then it says I should have gotten 70% of the bill.
[AGENT][NEUTRAL] So that sounds like you're looking at a because we don't use a network and you mentioned PHCS is that right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what card is that that you're, are you looking at a card or just a pulse?
[CUSTOMER][NEUTRAL] I'm I'm, I'm just looking at what my bene I'm just looking at what my, they say my benefits are.
[AGENT][NEUTRAL] OK, because we don't pay in percentages.
[CUSTOMER][NEUTRAL] Um, hospitalization, urgent care, 70% coverage.
[AGENT][NEUTRAL] Yeah, that sounds like a major medical plan, but we, this is like a hospital indemnity, so it basically just, it's like kind of like, you basically get paid for a certain dollar amount for certain types of procedures. So it's, it's not paid at a percentage. We don't use a network. This is just gonna pay you $50 for an urgent care visit based on the policy. Now, major medical plans like that use the network.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Those usually have a copay and then they pay at a percentage. So I'm not sure if you have, um, maybe that's the policy that you're thinking of, but this has like a list of services and then it pays a certain dollar amount and for this service it pays $50 regardless of any other insurance that you have, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, submit OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what will so what will happen next? I, I, I, um, I'll call the other phone number, yeah.
[AGENT][NEUTRAL] And again, I
[AGENT][NEUTRAL] So it's it's in like
[AGENT][NEUTRAL] OK, OK. Yeah, it's in line for processing, so give it about 7 working days. It should be processed and then you'll receive payment for $50 for this visit.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, and that will be sent by check because I didn't do any type of direct reimbursement.
[AGENT][POSITIVE] That is correct. Yes, it'll be sent by check. And again, I apologize for all of the problems on this and how, how difficult it was to get this accomplished. I'm so sorry about that.
[CUSTOMER][NEUTRAL] That's OK, um, not your fault.
[CUSTOMER][POSITIVE] But thank you. I really appreciate I finally got somewhere talking to you, so I'll just, I'll just wait for the $50 check.
[AGENT][NEUTRAL] OK, and anything else I can help with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Um, no, that was it. Thank you so much.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you. Thank you. Bye-bye.
[AGENT][NEUTRAL] All right, bye.