AccountId: 011433970860
ContactId: 0da6105d-7046-49e8-bafd-4cb6b442f077
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437760 ms
Total Talk Time (AGENT): 117057 ms
Total Talk Time (CUSTOMER): 278574 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/0da6105d-7046-49e8-bafd-4cb6b442f077_20250523T16:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes. I received the payment bill from the
[CUSTOMER][NEUTRAL] Uh, request the diagontics, and then I wanted to make sure that um this is not covered by the insurance or if there's any mistakes. Just wanted to confirm with that.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do. Um 01937190.
[AGENT][NEUTRAL] And can I get your first and last name?
[CUSTOMER][NEUTRAL] [PII]. Last name [PII]
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And do you have a good callback number in case we are disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. And then lastly, I just need your address and email address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, address [PII].
[CUSTOMER][NEUTRAL] Email address is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, and we were checking on, did you get an explanation of benefits from us? Have we processed the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, I see, I didn't follow up this bill, so I was like, oh, it's better to call you guys and just take a look at the records. It was done in the [PII].
[CUSTOMER][NEUTRAL] Uh, it was for the [PII], my son. He's also under my insurance.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So everything he gets, uh, you know, he covered. So there's a 4 test descriptions. LI lipid panel.
[CUSTOMER][NEUTRAL] BBC Plant electron.
[CUSTOMER][NEUTRAL] Then youuncture.
[CUSTOMER][NEUTRAL] Comprehensive metabolic panel, I'm so sorry. I'm not reading it clearly, but it was the procedures was done in [PII]. There's a CPT code. I have it on my bill. And this is done in the laboratory, which is the Quest Diagonistic.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] So, um, it's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you see anything on your end on the record, right? You, you guys see that, right?
[AGENT][NEUTRAL] Uh, we did, um, this, yeah, that policy, uh, it looks like the policy did not cover it. It doesn't cover lab work.
[CUSTOMER][NEUTRAL] With it, oh, OK.
[CUSTOMER][NEUTRAL] Oh, really? Not at all.
[AGENT][NEUTRAL] Not at all, yeah.
[CUSTOMER][NEUTRAL] Oh, OK. So, um, uh, let me ask you another question then. stuff like this, is there any way I can do the different procedures to get covered, or if the insurance doesn't cover all this type of um labs at all?
[AGENT][NEGATIVE] Uh, the insurance doesn't cover under this policy. It's a very limited policy, and it doesn't have any coverage at all for lab work.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, another question. I know that uh my insurance has some tiers, like tier one or two whatever, the better tiers, right? So if I increase my tiers, not, not right now, I, I can't do it, but when, when time comes to enrollment and be able to select the new tiers at that time, then is there, if I choose the different options for the insurance, is this gonna be covered? Is that right?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, I would have to transfer you over to benefits and a card. They could tell you what was available if you wanted to upgrade your policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, because there's several different options and I, I'm not sure if if lab would be a part of that option.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, yeah, there's a lot of uh a lot of stuff to see and know, right?
[CUSTOMER][POSITIVE] I see. I just, OK, thank you so much. You, OK, yeah, go ahead.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, like I said, it benefits in a card. They're the ones who have like the different tiers and what's available and then also I, I know they typically will do it like once a year you can um look at all the different options.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes. What about the blood test? Do, do you know anything like that it's gonna be covered or not covered? Or um before I take any actions when I go to like a hospital, is there a way I can find it out in advance that it's gonna be covered or not covered?
[CUSTOMER][NEUTRAL] Or before I take it because a lot of times I just do it and then later, you know, I get the bills later on high bills like, you know, so I will need to know uh what other options I can put it in the action. Do you know what I'm asking, right?
[AGENT][NEUTRAL] Yeah, so what's covered under your policy so um do you have access to like a laptop or desktop you can set up your account online on our portal and then it has your policy certificate.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, I do have a porter.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have an account with you guys. Uh, I, I remember I opened one and then I do have access is so there's something that I can take a look at it from there.
[AGENT][NEUTRAL] Yes, it's on your dashboard there'll be uh documents it's called your policy certificate, like where your policy number is, you should be able to click on it and then it'll pull up what's covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, OK. That's the good starting from there. Oh, OK. You know what, actually, let me take a look at those first before I ask a lot of questions, you might be answered there already. [PII]ogize and thanks for your time. Yeah.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] OK. Anything else I can help with, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, is [PII] and [PII] is, is on the policy. Just wanted to confirm.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] I believe so, but
[AGENT][NEUTRAL] Yes, they, yep, they are both covered.
[CUSTOMER][NEUTRAL] Just double check.
[CUSTOMER][NEUTRAL] Oh, OK. I, uh, last question, if I remove one of my son cause he's [PII] and he has his own insurance too, do I save some money or no?
[AGENT][NEUTRAL] Um, you'd have to talk to benefits and a card about the premium, um, that's, that's another one that they handle.
[CUSTOMER][NEUTRAL] I see. Got it.
[CUSTOMER][POSITIVE] I see. Got it. Thank you so much. You have a great weekend.
[AGENT][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Thank you for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bye-bye.