AccountId: 011433970860
ContactId: ffcdccb0-355e-4672-a5b4-3e89fc791bc3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490119 ms
Total Talk Time (AGENT): 213959 ms
Total Talk Time (CUSTOMER): 199185 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/ffcdccb0-355e-4672-a5b4-3e89fc791bc3_20250206T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, I received a bill from for an annual physical of $836 and I was covered by you guys at the time, and I'm just kind of curious if it was if the claim was processed correctly or if we need to reprocess it or what the situation is. I'm just trying to get down to the bottom of it.
[AGENT][NEUTRAL] Sure, I can definitely help you with your claim, um, and see what's going on with it. Mr. [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, my my uh number is [PII].
[CUSTOMER][NEUTRAL] And policy number, I don't, where would I find that at?
[AGENT][NEUTRAL] Um, on your card, it should say in hospital or outpatient policy cert number.
[CUSTOMER][NEUTRAL] I've got
[CUSTOMER][NEUTRAL] Mm, I have an employee employee ID employee name and medical coverage, um.
[AGENT][NEUTRAL] I can look it up with your social also. Do you see APL to the top left of the card?
[CUSTOMER][NEUTRAL] I should
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] APL, I don't. Oh yes, I do. Um, the policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see, uh, this is for dental though, the APL card that I have, would it be the same policy number?
[AGENT][NEUTRAL] Um, no, but I could, that policy will give me all your policies, I can still use it.
[CUSTOMER][NEUTRAL] OK, um, it's 02461014.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Um, my mailing address is [PII].
[CUSTOMER][NEUTRAL] Or I'm sorry, [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So let me take a look at the claim. Is this for um Saint Luke's Hospital [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. I'm, I, I currently, I, I, I'm so I was with Creative Circle, um, and I had the benefits through you guys through them, um, but on the [PII] I, I was hired on by the company I was, I've been working for, so I have different insurance now, but I should have been covered at [PII] through APL.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] For December.
[AGENT][NEUTRAL] OK, and this is wellness. OK. So the policy, so it's not that you weren't covered, you are covered. Your policy for wellness exams pays $75 per test.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So, that $75 was applied to this claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So the year before I had the annual physical and labs and it was fully covered.
[CUSTOMER][NEUTRAL] Through you guys.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So um is that something that is that something that changed in the last year or?
[AGENT][NEUTRAL] I'm just, so who did you have the
[CUSTOMER][NEUTRAL] was
[AGENT][NEUTRAL] It wasn't with APL. This is your first policy with all of your policies with us started on [PII]. This actually is the only claim we've ever processed for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So man, so I owe $836 from that uh annual physical.
[CUSTOMER][NEGATIVE] I'm, I'm just, it's kind of off a little bit. I mean, it doesn't make sense. I owe $1000 almost for a physical.
[AGENT][NEUTRAL] So now
[CUSTOMER][NEUTRAL] For just an annual checkup.
[AGENT][NEUTRAL] Now, if this was like a major insurance like Aetna, Blue Cross Blue Shield, Cigna, you know, you have those um benefits for your yearly that's once a year that's free, but this is a limited medical policy, so it's just like a certain dollar amount for, you know, whatever service is being done. I don't know if maybe if you had a major insurance last year, that could be why it was fully covered because I know those policies do do that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] For like your yearly, you know, you have like that one for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, so there's no if it's reprocessed in with any different it it nothing's gonna change. I still owe this amount.
[AGENT][NEUTRAL] Unless you have other
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Unless you have other medical, OK.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah, I don't. That that's the only medical I had at the time.
[CUSTOMER][NEUTRAL] But I, it's weird because
[CUSTOMER][NEGATIVE] I don't know. Did, did my children have annual physicals? because I have 3 kids that I'm covering too, and I've never received a bill for them.
[AGENT][NEUTRAL] Your children, let me see.
[CUSTOMER][NEUTRAL] And I'm sorry, I'm just trying to figure it all out. I'm not um.
[AGENT][NEUTRAL] No, no, you're fine. That's what we're here for.
[CUSTOMER][NEUTRAL] No shots towards you. I'm just trying to get it all figured out.
[AGENT][POSITIVE] It's no problem at all.
[AGENT][NEUTRAL] Uh, let me see. You said for your children, look and see if theirs were paid in full?
[AGENT][NEUTRAL] Now, I do see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, looks like his last the last claim we processed for [PII] was [PII]. That one is the same because the benefits are the same, so $75 was also applied to that. This one looks like it was an office visit though. I don't think it was a.
[CUSTOMER][NEUTRAL] Well that, well that's what, that's what this was, this was an office visit as well because it was the same thing as my annual checkup.
[AGENT][NEUTRAL] Like a testing.
[AGENT][NEUTRAL] Well, those, so, OK, so you have either way it's still $75 but you have like your wellness benefits, there's there's specific benefits for wellness and diagnostic testing and then like office visits.
[AGENT][NEUTRAL] So yours was under wellness because it was your yearly.
[CUSTOMER][NEUTRAL] So the 8
[CUSTOMER][NEUTRAL] Is the 8:36 from my diagnostics or from my office is it?
[CUSTOMER][NEUTRAL] That can you tell that?
[AGENT][POSITIVE] Well, it just came over as well as wellness, so it's your wellness benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, do you have, can I get a.
[AGENT][NEUTRAL] But for your
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Oh, go ahead. I'm, well, I was just wondering, I was told by [PII] to get a call reference number. Is there anything where I could get that from you?
[AGENT][NEUTRAL] Yeah, um, so there's no call reference number, but you can use my name in today's date. So again, that's [PII]
[AGENT][NEUTRAL] First initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And also if you'd like to, um, if they want to ever check the benefits of Verify, they can definitely give us a call. We'll be more than happy to help them with the coverage as well too.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well I appreciate it I'll give them a call back.
[AGENT][NEUTRAL] Alrighty, well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no thank you. That's it.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You do the same thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.