AccountId: 011433970860
ContactId: 0c4a355d-fee2-4415-8aed-4fa38f4e99bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297390 ms
Total Talk Time (AGENT): 83789 ms
Total Talk Time (CUSTOMER): 121897 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/0c4a355d-fee2-4415-8aed-4fa38f4e99bc_20250422T14:42_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I received the explanation of benefits for a claim that I submit.
[CUSTOMER][NEUTRAL] Uh, and I would like someone to help me to understand why it's not covered.
[AGENT][NEUTRAL] OK, um, I can help you with that. What was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how do you spell that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, 023371-19.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I have the claim number here if you need it.
[AGENT][NEUTRAL] OK. And you, are you the insured or are you with the provider?
[CUSTOMER][NEUTRAL] No, on the insurance.
[AGENT][NEUTRAL] OK, thank you. And what's that claim number, please?
[CUSTOMER][NEUTRAL] The claim number is 3589935.
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] 12475.
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you asked me for it the email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how do you pronounce your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Miss [PII].
[AGENT][NEUTRAL] And you want an explanation on claim number 3589935. I can help you with that. Um, hold on just a moment, let me look it up for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's very clear on the description. I just wanna make sure because my claim was only for the injection.
[CUSTOMER][NEGATIVE] Not for the office visits.
[AGENT][NEUTRAL] Let me pull up the claim.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, on this policy, it does not cover uh office visits or anything done in a doctor's office.
[CUSTOMER][NEUTRAL] Even um but my question is when they go through my deductible and in an outpatient setting, it's not because it's on a hospital outpatient.
[CUSTOMER][NEUTRAL] It's outpatient because it's the specialist office.
[AGENT][NEUTRAL] OK, Specialist office visits are not covered or anything done in that office is not covered.
[CUSTOMER][NEUTRAL] Wow, never happened before. OK, all right.
[AGENT][NEUTRAL] You do not have the office visit or the uh.
[AGENT][NEUTRAL] Service benefit.
[CUSTOMER][NEUTRAL] No, no, I never asked for the office visit.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Yeah, just the injection because they said I have to go through my deductible. It never happened before because I've been having asthma for a long time and I had the same injection in [PII] and I never received a bill and I paid $324 for that injection for the J code that day.
[AGENT][NEUTRAL] OK, this policy wouldn't affect it to 51 of 23.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Right, right, yeah, we change every May, OK.
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, no, thank you very much for your help, OK?
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.