AccountId: 011433970860
ContactId: ff75120a-e5b8-4a1c-9156-2766756d7dbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522330 ms
Total Talk Time (AGENT): 228253 ms
Total Talk Time (CUSTOMER): 189978 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/ff75120a-e5b8-4a1c-9156-2766756d7dbe_20250212T17:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I didn't hear your name. I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hey, [PII], um, my name is [PII].
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], um, how can I help you today?
[CUSTOMER][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] I'm calling because I got some questions and.
[CUSTOMER][NEUTRAL] I'm trying to um.
[CUSTOMER][NEUTRAL] Retrieve money.
[CUSTOMER][NEUTRAL] That I had paid out to get have a knee surgery.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And um I've been trying I've been trying like 67 times, and I'm at the point now where you all gave me $694.71. So I'm trying to see, um, the what is that just the first payment or do I, would I be receiving more that's my question.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK [PII], um, I can help you with your claim. Uh, can you please give me your call back number sir just in case our call is disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Hold on, the policy number is, hold on one second.
[CUSTOMER][NEUTRAL] Clothes.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Go ahead and take your time.
[CUSTOMER][POSITIVE] OK thank you I appreciate that.
[CUSTOMER][NEUTRAL] Lord knows I need some.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I think it is.
[AGENT][NEUTRAL] I do too.
[CUSTOMER][NEUTRAL] 241-976-8 uh.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My address is
[CUSTOMER][NEUTRAL] Um, [PII], and whatever my email address should be, I guess that is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, I have your, your street address is different. Have you moved?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, oh.
[CUSTOMER][NEUTRAL] No, my street address is [PII].
[CUSTOMER][NEUTRAL] No. Oh, you, oh it's in my old house [PII].
[AGENT][POSITIVE] OK, yes, that's the one I have for you.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, and then the number that you gave me to call you back on if we get disconnected, is that your cell phone?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me add that in because I have a different number for you, um, one minute, let's see.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] I'll be just a second. My computer is decided to think.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I've got it together sir alright so you're calling because you submitted claims.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You have had one payment and you're wondering if it's gonna pay any more on the claim that you already had paid on?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and I did it. The thing I would do is I did direct deposit, but I didn't get any money yet, so I don't know how that's working, but oh.
[AGENT][NEUTRAL] OK, so I'm showing that you did have a claim um that was paid $694.71 by direct deposit, um, it was for your outpatient services with advanced orthopedic and sport.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for [PII].
[CUSTOMER][NEUTRAL] And now so that.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so that claim was paid and then
[AGENT][NEUTRAL] I'm showing that we have a claim that
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] was filed on
[CUSTOMER][NEUTRAL] Go ahead, I'm.
[AGENT][NEUTRAL] I'm showing that we had a yes sir I'm, I'm looking at the claims for you. We had a claim that was filed on [PII] for Ortho Florida.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much uh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It says
[AGENT][NEUTRAL] Oh, I'm sorry, it was the um
[AGENT][NEUTRAL] Let me look, I think it's the facility that filed the claim.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK, so we did have a claim that was filed on [PII] and the remarks on that claim is office visits are not covered under the policy, so the office visit will not be paid for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] That means your insurance covered it.
[AGENT][NEUTRAL] So we, we only pay for deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Deductible copay, and
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK, yeah, OK, but my co-pay was $4000.
[AGENT][NEUTRAL] So the remark on
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look at your benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on your benefits for outpatient per calendar day.
[AGENT][NEUTRAL] You're allowed $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they paid the $500.
[AGENT][NEUTRAL] We paid, yes.
[CUSTOMER][NEUTRAL] But what about, what about, but with surgery, I had a surgery. That's the thing. I had a surgery and they charged me $4000 to, to have the surgery.
[AGENT][NEUTRAL] OK, so as far as the rest of your payment goes that you owe to the hospital, I would talk to them and see if they can work something out with you because we paid we paid the $500 that your policy says that we will pay.
[CUSTOMER][NEGATIVE] That's, well, I don't understand that.
[CUSTOMER][NEUTRAL] So you only pay 5.
[AGENT][NEUTRAL] We're not the primary, we're not the primary insurance, we're secondary.
[AGENT][NEUTRAL] So you, you might wanna talk to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The facility that you had your surgery done at, talk to them and see if they can work something out with you because your secondary insurance paid the part that your policy says that we'll pay.
[CUSTOMER][NEUTRAL] And that's OK, so let me ask you a question.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So if my deductible was $4000 and I paid the $4000 and you said that you all pay deductibles, you all don't pay deductibles.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Up to $500.
[CUSTOMER][NEUTRAL] Or you only pay $500 for deduct.
[AGENT][NEUTRAL] Yes, only 500.
[AGENT][NEUTRAL] Per the way your policy is written.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] And who wrote the policy?
[AGENT][NEUTRAL] That's the policy that was issued to you through your employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So out of $4000 you are already giving me $691 that's what you're saying.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] OK, you're very welcome, Mr. [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.