AccountId: 011433970860
ContactId: 0862c0f5-7063-41c6-be63-541e53365a52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635090 ms
Total Talk Time (AGENT): 277001 ms
Total Talk Time (CUSTOMER): 321639 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/0862c0f5-7063-41c6-be63-541e53365a52_20250306T21:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I had a, um, question about a claim.
[AGENT][NEUTRAL] OK, I can.
[CUSTOMER][NEUTRAL] Of mine
[AGENT][NEUTRAL] Do you have, uh, what's your name and the policy number, please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and the policy number is 1836605.
[AGENT][NEUTRAL] 1836605
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII]. Um, mailing address is [PII], and email address is [PII].
[AGENT][POSITIVE] Awesome, thank you, ma'am. And you say you're calling for a claim status, is this for yourself?
[CUSTOMER][NEUTRAL] It's no, it's for my daughter [PII].
[AGENT][NEUTRAL] For [PII], OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Was this a recent claim or you have a question about how it was processed?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Well, yeah, I had a question about it, uh, how it was processed and I could be wrong because at this point I have a lot.
[CUSTOMER][NEUTRAL] Dublin, yeah, so that was processed. I think it was processed as an office visit, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh let's see. Do you happen to have that claim number or the date of service?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It, uh, data service I think was 219, I believe.
[AGENT][NEUTRAL] 219 of this year?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] Yeah, yeah, data service is 2-19-2025.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Uh, yes, ma'am, looks like you paid $50 which is the benefit max for an office visit.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] All right, she had an MRI done.
[CUSTOMER][NEUTRAL] During that visit. And I didn't, I thought MRI's were covered.
[AGENT][NEUTRAL] Uh, let me look at this claim. Give me one moment.
[CUSTOMER][NEUTRAL] I, I'm on the phone, baby. Just take, how about you take your backpack?
[CUSTOMER][POSITIVE] Out my car and take it inside the house, OK? I would really appreciate that hard.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Please take your backpack out of my car.
[CUSTOMER][NEUTRAL] Please take it out of my car and take the backpack inside the house.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I don't understand.
[AGENT][POSITIVE] The Kids are funny, I promise you. I have an [PII].
[CUSTOMER][NEUTRAL] I teach who you telling?
[AGENT][NEUTRAL] I just want to body slam them like 90% of the time. It's like.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] I know. I, I, I teach and
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] What grade did you teach?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I got more
[CUSTOMER][NEGATIVE] 5th and I got more paragraphs today. I'll miss you so much. Please don't ever get this sub, and I promise you I act right if you just come back like you want me a longer essay asking me to come back than you have ever written me for any test.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] That's pretty funny.
[CUSTOMER][NEUTRAL] What, what is going on here?
[AGENT][POSITIVE] Kids are so funny though. It's 5th grade. Oh gracious. Yeah, my son will be there next year, so yay.
[CUSTOMER][POSITIVE] They are hilarious.
[CUSTOMER][NEUTRAL] That's different.
[CUSTOMER][NEUTRAL] Get ready, get ready.
[AGENT][MIXED] Yeah, he's, he's so, I guess he's, I always ask him, what did you learn new today? He's like, oh, I learned how to do fractions. So I was like, oh, that's cool. But he's like, I just hate school. It's like, well, you can't be homeschooled because I need help.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] Hey, my 4th grader hates it with, and I teach, she hates it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I promise you I'll stay at home and I won't open the door. She says that every day. I won't open the door for anyone.
[CUSTOMER][NEUTRAL] Sorry, kid.
[AGENT][NEUTRAL] She wanted to be raised like Gen X.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but yeah, I'm looking at the claim and I do show uh the code for diagnostic, but it processes benefits of max with that payment because under your policy you have an office visit benefit and if any procedures are performed in office or office visit, the max it pays is just that $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like if she had uh the diagnostic in an outpatient facility like an imaging center, that's covered on the outpatient benefit, but since it was in the office, it just went towards that office visit benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Well, maybe that's why I, well, maybe that's why I messed up because it was two separate visits. She did the MRI on the [PII].
[CUSTOMER][NEUTRAL] What is the [PII] and I do like she did the [PII] and then she did the office visit on the [PII], so there were two separate.
[AGENT][NEUTRAL] OK, and for the, um, when she had a scanning, was it in an outpatient facility or imaging center?
[CUSTOMER][NEUTRAL] Occasions.
[CUSTOMER][NEUTRAL] I don't know how his place like it's.
[CUSTOMER][NEUTRAL] All one it's like separate compartments. Does that make sense to you?
[AGENT][NEUTRAL] I think I get what you're saying.
[CUSTOMER][NEUTRAL] Like they have an imaging, they have like an imaging center that does strictly imaging only. You have a separate entrance for imaging and then you do a separate entrance for like office visits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] So her imaging was through the
[CUSTOMER][NEUTRAL] Imaging only
[CUSTOMER][NEUTRAL] Center, it was on a different date on the [PII]. It was on the [PII] or the [PII] because we had to wait.
[CUSTOMER][NEUTRAL] week for that.
[AGENT][NEUTRAL] And it's also
[CUSTOMER][NEUTRAL] I don't even know what date was on that.
[AGENT][NEUTRAL] What their license because they can be like a doctor's office and then an imaging center could be the same spot, but if it's like a bill from the physician's portion of the visit, um, then we're all going to pay for the visit for office visit, but the imaging is a, it's own separate entity, I guess you could say for tax purposes, like if they're licensed as an imaging center, then that will follow under the outpatient benefit is the imaging center.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I would say to contact the provider for that [PII] data service, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And request billing and the primary EOB because we hadn't received any claims for that date.
[CUSTOMER][NEUTRAL] We sure didn't.
[AGENT][NEUTRAL] Because it could be they
[CUSTOMER][NEUTRAL] You sure did not cause I thought about that after I called you. I was like that's when we actually went in, but she did her MRI.
[CUSTOMER][NEUTRAL] We prior to that it was strictly for the MRI and then we had to go in for an office visit, as a matter of fact, I know it was two separate locations because we had to go to [PII], which is 45 minutes away from where we live, for the um.
[AGENT][NEUTRAL] That's my hometown.
[CUSTOMER][NEUTRAL] Oh, for real? OK. So we have to go.
[AGENT][NEUTRAL] [PII], yeah.
[CUSTOMER][NEUTRAL] OK, yeah, we had to go to tomorrow strictly for the MRI and then we had to go restsin for the actual office visit, so.
[CUSTOMER][NEUTRAL] Then it was strictly for the MRI.
[AGENT][NEUTRAL] I want
[AGENT][NEUTRAL] The one in uh for the visit, is that like a follow-up after the MRI?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that could be, um, it could be two separate.
[CUSTOMER][NEUTRAL] Because that was a follow up, that's how we met with the doctor because we didn't need it that was strictly just imaging for the uh MRI.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yes, ma'am. I will say to contact uh that place where she had the MRI and get the billing and that primary EOB and or not primary EOB, the itemized billing showing the diagnosis and procedure codes and the charge and send that in to us for us to process.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm glad I thought about that. I was like, I remember we had to drive somewhere. It was a long drive. I just, and I'm thinking it's long because her name was [PII] and it was just the roads are rough. I just remember that being.
[CUSTOMER][NEUTRAL] A long ride. Got you. OK.
[AGENT][NEUTRAL] I was saying I have family in [PII].
[CUSTOMER][NEUTRAL] Really, that's, that's really a small world.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, we've been here for a while.
[AGENT][POSITIVE] I miss [PII]. I do. I love being in [PII].
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Are you're, you're in [PII]. I get a lot of calls like ro it to a lot of people who are in [PII].
[AGENT][NEUTRAL] Yeah, I'm in [PII].
[CUSTOMER][NEUTRAL] Are you, are you in [PII]? Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, it's not that far, but it's uh when you in a different state and you're, you're just here, you don't have a reason to go there often. Last time I've been there was just to go to [PII] for a concert, but that's the only time I.
[CUSTOMER][NEUTRAL] Different.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In recent time in [PII], you know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, resting is nice. We got a lot of stuff going on. It's so pretty. So like, yeah, you gotta come visit soon. It's, we got a lot of stuff going on. Rein is coming on up.
[AGENT][POSITIVE] Oh yeah, I love being in the South. I absolutely love being from the south. Like my favorite, uh, I, I know we're supposed to talk work, but my favorite thing is I always love the trees, the moss on the trees, it's just like that it's just quintessential Southern, and it's just, I don't know, it's a homely feeling.
[CUSTOMER][NEUTRAL] Yeah, me too.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Yeah, and my husband, he's in [PII] and, and he always says, why are you in the shoes on? I'm like, why you got all the shoes on, like.
[AGENT][NEUTRAL] There's browning.
[CUSTOMER][NEUTRAL] I'm like if I can make it outside, uh, and I ain't no shoes, I don't put them on. Why you got your shoes in your socks tied all the way up to your ankles like what you got going on, kid?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Always. Like he always, you got some shoes with you. They in the car. Don't worry. I won't shame you in public.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's pretty funny.
[CUSTOMER][POSITIVE] Yeah, it is. He always gets on about them. Well, thank you so much, and I'm gonna, uh, remember to go check on that and call them and say I can get that information from them.
[AGENT][POSITIVE] OK, um, well, I thank you for calling APL and you have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.