AccountId: 011433970860
ContactId: 0d26fc58-545e-42fb-b802-897ce6605acc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217529 ms
Total Talk Time (AGENT): 95030 ms
Total Talk Time (CUSTOMER): 112670 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/0d26fc58-545e-42fb-b802-897ce6605acc_20250212T13:54_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, I need some um assistance with the claim that I had um put in.
[CUSTOMER][NEUTRAL] Um, the description, um, didn't make sense to me. Can I give you the claim number?
[AGENT][NEUTRAL] Can I have a policy number?
[CUSTOMER][NEUTRAL] Sure, um, 1670175.
[AGENT][NEUTRAL] And can I have your name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII] um [PII] of.
[CUSTOMER][NEUTRAL] Oh my gosh, [PII] and uh [PII].
[AGENT][NEUTRAL] And and you, what is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And what is your email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and you're calling in regards to a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Um, 3561989.
[AGENT][NEUTRAL] For treatment received in the doctor's office not being covered?
[CUSTOMER][NEUTRAL] So it wasn't a doctor's office. I went to a center. I went to Acu um.
[CUSTOMER][NEUTRAL] Palm MRI or something like I went to a center.
[AGENT][NEUTRAL] So that means you need to send me some more detailed information.
[CUSTOMER][NEUTRAL] So the first time I.
[CUSTOMER][NEGATIVE] I did if you look at the one before that I did send this and then it you then I called back because it was denied then so I went to this um.
[CUSTOMER][NEUTRAL] Where's the paper where I went.
[CUSTOMER][NEUTRAL] The Palm center and then you guys need the explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So since I paid cash, that's what they gave me.
[CUSTOMER][NEUTRAL] That receipt, it wasn't done at the doctor's office.
[AGENT][NEUTRAL] No, you need an itemized bill see because right now, so this information that you gave is like a it says primary medical physician reason for visit then it gives all the descriptions of the visit. So but it's saying that it's a doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're receiving services in the doctor's office. So you may wanna reach out to them to request an itemized bill and it would just break down actually everything if it was a considered as an office visit or diagnostic testing, but if, if it.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] From the diagnostic center, from the diagnostic center.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] From whom this [PII] for this data services.
[CUSTOMER][NEUTRAL] No, that's just the doctor's office. That's just the doctor's office that's, and then I went to a center to have this done, and that's the receipt because I paid cash and I didn't like the receipt she gave me, but um, that's the receipt I submitted, so you need the itemized bills from the center.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yes, because right now it says cost of care from my provider, meaning that services received from your provider, it's not covered in all, it's not covered.
[AGENT][NEGATIVE] In the office, not in the office, it's not covered, but asking for an itemized bill.
[CUSTOMER][NEUTRAL] Yeah, uh, OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, I think so.
[CUSTOMER][NEUTRAL] OK, from the center.
[AGENT][NEUTRAL] Yes, so if you got diagnostic testing done, then you get that from the center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, alright, let me give them a call thank you.
[AGENT][NEUTRAL] Cause diagnostic testing is covered under your policy. You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] OK, all right. Thank you. No, no, no, thank you, you're very helpful.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Mhm bye bye.