AccountId: 011433970860
ContactId: f8f85d3a-eb31-49bd-9c91-9b1b298e1492
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558619 ms
Total Talk Time (AGENT): 196388 ms
Total Talk Time (CUSTOMER): 205036 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/f8f85d3a-eb31-49bd-9c91-9b1b298e1492_20250618T21:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I mean this is um I was calling because uh I received like a letter in the mail from you guys saying that you guys are trying to process a claim from um.
[CUSTOMER][NEUTRAL] [PII] from [PII], but I actually, um, haven't had you guys, I haven't had insurance with you guys since the end of April, I think, um, and I started with them on May, so I don't know why I had received this letter.
[AGENT][NEUTRAL] OK. Did, did it reference a policy number or?
[CUSTOMER][NEUTRAL] There's a claim number and also a policy number, actually.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 02560005.
[AGENT][NEUTRAL] OK. And could I get your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is your birthday, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then can you verify your address and email address?
[CUSTOMER][NEUTRAL] My address is [PII], and my email address is [PII].
[AGENT][POSITIVE] OK, thank you. And just in case we're disconnected uh what's a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Um, OK, so you said you terminated from this employer back in April?
[CUSTOMER][NEUTRAL] Well, um, sort of, uh, it was like, it's um
[CUSTOMER][NEUTRAL] It's like an employment agency, and I was still under the agency, but now I'm working for them but under like in corporate. So I was hired on to the same company, if that makes sense.
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What was the claim number on that?
[CUSTOMER][NEUTRAL] Um, the claim number is 3,611,210.
[AGENT][NEUTRAL] OK, it looks like let's see.
[AGENT][NEGATIVE] Uh, well, we got the claim from the provider, so that's why we had processed it, but we, we've denied it because we don't show that it's that you're covered still. We showed you terminated on [PII].
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, that makes sense then.
[CUSTOMER][NEUTRAL] But I was wondering also, I know that there should be other claims from February and March. I don't know if those have been completely processed or not because I haven't received any bills or anything.
[CUSTOMER][NEUTRAL] I did receive like a couple letters, but I'm not sure what they meant.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] OK, it looks like we've got two claims on file that we paid. One was for 227, 25 for ER.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You paid 100.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Cause this is just like a small supplemental policy. It doesn't have a lot of benefits to it, um.
[AGENT][NEUTRAL] And then there was a claim from [PII] and we for ER and we paid 100. That was the benefit for the plan.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this um
[CUSTOMER][NEUTRAL] Yeah, but other than that, you hadn't received anything else?
[AGENT][NEUTRAL] Um, received.
[AGENT][NEUTRAL] Hold on just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Also received a claim for
[AGENT][NEUTRAL] Uh, looks like it was a, a claim for the same date, 227.
[AGENT][NEGATIVE] Looks like we received it twice, um, and then 31 same thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Because like I had to call a while.
[AGENT][NEUTRAL] Did you have other claims?
[CUSTOMER][NEGATIVE] No, it should just be those cause I had called a while back. I actually called [PII] asking him about the bills, and then um they said that it was like a, cause I got like ultrasounds and stuff done, so they said that it was gonna be like a large bill, but that they were gonna go through you guys' bill, but I hadn't received anything in regards to that. I had did receive those um $100 coverage, but I didn't receive anything else.
[AGENT][NEUTRAL] Right, and that's um because the coverage under this policy, it's just a very limited plan. So that's all that it pays is $100. It's not like a major medical coverage. It just has a max payout of 102 days per calendar year for ER. That's, that's all it will pay.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Even, even for the procedures that we're done?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So like I was paying like over $100 a month, like you guys would only pay $100 to cover that?
[AGENT][NEUTRAL] Yeah, this is the, the benefit for this policy is, is $100 twice per year for ER.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this premium was 23.75 per month. So I don't know if maybe there was something else that you had that
[AGENT][NEUTRAL] It was maybe through a different carrier.
[CUSTOMER][NEUTRAL] Yeah, but I paid, no, cause I would pay per week. I would pay 23, I would pay $37 per week, but I did have um
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] 0, 23 for me.
[CUSTOMER][NEUTRAL] Yeah, it was 23 per week. So I was paying like almost 100 just for the medical.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] Yeah, that's the the plan that you're um um temp agency, it looks like that's what they've offered, so.
[CUSTOMER][NEUTRAL] But um,
[AGENT][NEGATIVE] Yeah, it is a very limited policy, unfortunately.
[CUSTOMER][NEUTRAL] OK. But did you guys get a bill for the, for the procedures that they did, or was it just like the $500 bill that they charged there for the?
[CUSTOMER][NEUTRAL] And millions and stuff like that.
[AGENT][NEUTRAL] Uh, it was the bill for
[AGENT][NEUTRAL] The facility charge, so for the hospital charge, Kaiser Foundation.
[AGENT][NEUTRAL] That's 6,382 and then there was a charge for same hospital for 6,946.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] You got a claim for same same charges, that looks like it's just for the physician charge $682 and then
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Same charge again, 682.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And, and then all like you guys just covered $200.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. And I wouldn't have changed if I would have gone to like another.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hospital hall.
[AGENT][NEUTRAL] No, that the benefit correct. It would be the same benefit no matter what hospital you went to.
[CUSTOMER][NEUTRAL] Either way you guys would have just.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And are you guys going to bill me or would they bill me?
[AGENT][NEUTRAL] Um, they would bill you.
[CUSTOMER][NEUTRAL] Do that.
[CUSTOMER][NEUTRAL] All right. OK then.
[AGENT][NEUTRAL] OK. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, so like if I want to like dispute anything with you guys or anything, is there a different number?
[AGENT][NEUTRAL] Um, no, you can send in a written appeal.
[AGENT][NEUTRAL] Um, to our, our claims mailing address, if you want to like appeal the decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, do you have our claim? It should be on our, um, that letter that you received, there should be our claims mailing address and then you can just write in an appeal and tell us, you know, what you're disputing.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] OK, sounds good, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good afternoon.