AccountId: 011433970860
ContactId: fd1ce3c6-6668-4a6c-b1f6-57125593410b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385380 ms
Total Talk Time (AGENT): 175449 ms
Total Talk Time (CUSTOMER): 121170 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/fd1ce3c6-6668-4a6c-b1f6-57125593410b_20250519T20:57_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello there. Yes. Uh, my name is [PII]. I had a, a visit recently with the doctor in the Mercy clinic, and I got an EOB that said it wasn't covered. I just wanted to see what was the reason, uh.
[CUSTOMER][NEUTRAL] That the visit wasn't covered.
[AGENT][NEUTRAL] OK, so you are the insured and you had filed a claim with APO but it was denied and you're just wanting to find out why?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Right, so I'm, I'm the insured person, yep, I was the patient.
[AGENT][NEUTRAL] OK, I can help you with that and
[CUSTOMER][NEUTRAL] Um, and
[AGENT][NEUTRAL] Yes, sir. Well, I can take a look at it for you and Mr. [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Policy number 01792136.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get your information pulled up.
[AGENT][NEUTRAL] Hi, Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So as I stated, I will have to verify several things with you first for security. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the claim is for you, is that correct? That you're wanting to go over? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then if you also verify your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so that is the best number that we should have for you, is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, thank you. And lastly, your email address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and Mr. [PII], you said that you do have a claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is that claim number?
[CUSTOMER][NEUTRAL] 359.
[CUSTOMER][NEUTRAL] 8372
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so this is for [PII] Oklahoma, is that correct? For data service for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So yes, sir, this claim was denied because office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] It doesn't that go towards my deductible? I mean, I have an office visit copay and then beyond that would go towards my deductible.
[AGENT][NEUTRAL] Yes, sir, but your supplemental policy does not cover the office visits, so therefore, it would not, there would be not, excuse me, there would not be any benefits on this policy for an office visit.
[CUSTOMER][NEUTRAL] So you're saying it only covers procedures?
[AGENT][POSITIVE] That is correct, yes sir.
[CUSTOMER][NEUTRAL] OK, because my understanding was it didn't cover office visit co-pays. Why does it not cover, why does it not cover the office visit itself?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Because office visits aren't covered under this policy.
[CUSTOMER][NEUTRAL] That hasn't always been true in the past. We've had this policy for the last 6 years and it seems to cover less and less over time.
[CUSTOMER][NEUTRAL] Has the policy changed over time?
[AGENT][NEUTRAL] Mm. No, sir, it doesn't appear that there have been any changes. Treatment within the office can be reviewed, but the office visit itself isn't covered.
[CUSTOMER][NEUTRAL] OK, so there wasn't any procedures submitted for this.
[AGENT][NEUTRAL] No, so there wasn't.
[CUSTOMER][NEUTRAL] Um, because I had a I had a, OK, because I had a procedure done with this office.
[CUSTOMER][NEUTRAL] So that that wasn't submitted as a claim?
[AGENT][NEUTRAL] There's no, let me double check.
[AGENT][NEUTRAL] For data service for [PII], no sir, this is the only claim that we have on file, and that's for the visit.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for your time.
[AGENT][NEUTRAL] Now you're welcome. And then one more question, um, Mr. [PII], have you ever set up your profile in our portal called the online service center?
[AGENT][NEUTRAL] Or you can have access online. OK, I'm gonna just go ahead and.
[CUSTOMER][NEUTRAL] I don't remember.
[CUSTOMER][NEUTRAL] I mean that's what I'm looking at. I'm looking at the online you talking about the log in yeah I that's how I found the claim was I log logged into the website.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, so good. Yes, sir. No, that's what I was referring to, so that's good that you have your profile set up. OK, so that you can see your information online.
[CUSTOMER][NEUTRAL] Is that what you mean, or is there something else?
[AGENT][NEUTRAL] But this claim was received, this claim for this data service that was received was for an office visit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, was there anything else that I could help you with this afternoon?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope that you have a nice evening.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] You're welcome. Bye bye.