AccountId: 011433970860
ContactId: f5b9843b-9055-4952-83c7-d1182af1b8f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492329 ms
Total Talk Time (AGENT): 152450 ms
Total Talk Time (CUSTOMER): 137906 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/f5b9843b-9055-4952-83c7-d1182af1b8f8_20250516T15:54_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is. May I help you?
[CUSTOMER][NEUTRAL] I was speaking with someone else and the line that did uh I'm calling about a paperwork I submitted.
[CUSTOMER][NEUTRAL] Um, regarding a hospital bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I received a form from my insurance company telling me I need to provide an itemized bill. I did so certified mail, um, that's been two weeks ago and I'd like to know what I'm receiving on that claim.
[AGENT][NEUTRAL] OK, and your name is, sir?
[CUSTOMER][NEUTRAL] Connect.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] I have my member number. I don't have a.
[CUSTOMER][NEUTRAL] Policy number is that what you need?
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Yes, sir. And you say your last name is [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No [PII]
[AGENT][POSITIVE] [PII] thank you so much. Give me one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I was.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][POSITIVE] Awesome thank you so much.
[AGENT][NEUTRAL] OK, see, Mr. [PII], uh, verify your date of birth for me, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] Uh, sure, it looks like the last claim we received, uh, processed on the [PII] of this month, and that process is not covered.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] On the night in terms into one another.
[AGENT][NEUTRAL] Uh, when did you submit the claim?
[AGENT][NEUTRAL] Because it looks like this was received on the [PII] by fax.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I, I mailed in a letter.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, ma.
[CUSTOMER][NEUTRAL] Certified mail.
[CUSTOMER][NEUTRAL] I had to fill out the document.
[CUSTOMER][NEUTRAL] And provide itemized um.
[CUSTOMER][NEUTRAL] Statement from the hospital.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] And this was outpatient hospital.
[AGENT][NEUTRAL] Like you weren't confined in patient in the in the hospital?
[CUSTOMER][POSITIVE] Uh, yes ma'am, yes, yes ma'am.
[CUSTOMER][NEUTRAL] Yes I was before colonoscopy.
[CUSTOMER][NEUTRAL] $18,000 and something, I believe.
[AGENT][NEUTRAL] Yeah, like.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, sir. I'm showing that uh claim was received, but process is not covered, lost under the plan.
[AGENT][NEUTRAL] Let me pull up the pass.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see one I'm pulling up your policy.
[CUSTOMER][NEUTRAL] Is that yeah.
[CUSTOMER][NEUTRAL] This is mailed on uh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The delivery 55 looks like.
[AGENT][NEUTRAL] Uh, that's what day we received it, yes, sir, and it was processed on the [PII], um.
[AGENT][NEUTRAL] Well, under your policy, uh, you don't have benefits for outpatient unless for like ER urgent care.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is for a colonoscopy.
[CUSTOMER][NEUTRAL] How was that in October, man?
[CUSTOMER][NEUTRAL] I mean you you're telling me that a colonoscopy is not covered.
[CUSTOMER][NEUTRAL] The cost
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Not under your policy, no, sir. Um,
[AGENT][NEUTRAL] Cause you have benefits for inpatient confinement, uh, for outpatient.
[AGENT][NEUTRAL] Accident or sickness treatment in the ER, urgent care or physician's office. Um, but I don't show any benefits as far as any diagnostic or surgery, like a colonoscopy would be considered like a surgical procedure.
[CUSTOMER][NEGATIVE] So I have no coverage for for surgery.
[AGENT][NEUTRAL] I don't show any surgical benefits under your policy, no sir.
[CUSTOMER][NEUTRAL] Holy cow.
[CUSTOMER][NEUTRAL] OK, I guess I need to change something then.
[CUSTOMER][NEUTRAL] Alrighty, I'm set with $18,000 bill.
[CUSTOMER][NEUTRAL] I thought I, I, I understood the lady told me there was exceptions.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I don't remember the exact verbiage, but
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Yes, sir. It's, uh, looks like the policy have just limited medical indemnity plan. And like I say, you have benefits for inpatient facility, outpatient for ER urgent care, office, or um clinic.
[AGENT][NEUTRAL] But I don't show any surgical benefits or any outpatient facility benefits under your plan.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm supposed to be having a.
[CUSTOMER][NEUTRAL] Uh, spinal cord stimulator implanted, that would be.
[CUSTOMER][NEUTRAL] An outpatient procedure so that wouldn't be covered?
[AGENT][NEUTRAL] Uh, no, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Uh, yes, sir. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.