AccountId: 011433970860
ContactId: 12cd3864-a7cd-404f-ae97-bc51f196fc36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419489 ms
Total Talk Time (AGENT): 154537 ms
Total Talk Time (CUSTOMER): 111767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/12cd3864-a7cd-404f-ae97-bc51f196fc36_20250129T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. I was calling to check the status of my claim. I just submitted it last week, I think it was, but I wanted to make sure it's received and it's being processed and everything.
[AGENT][NEUTRAL] I can help you. What's your name and policy number?
[CUSTOMER][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] Um, my name is [PII].
[CUSTOMER][NEUTRAL] And my policy number is 0222.
[CUSTOMER][NEUTRAL] 365 5.
[AGENT][NEUTRAL] OK, what's a good phone number, [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And, uh, what's your date of birth and mailing address?
[CUSTOMER][NEUTRAL] Um, [PII] mailing address [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, what's the city and state?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your email address?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thanks for that, [PII]. And what's your birth year?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, we have [PII], so it's [PII]?
[CUSTOMER][NEUTRAL] Yeah, I don't know how that happened.
[AGENT][NEUTRAL] Yeah, let me update that.
[CUSTOMER][NEUTRAL] Yeah, I wanna be [PII] old.
[AGENT][NEUTRAL] I know, right?
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Few more minutes to get this updated.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, and you said that you're checking on your your claim, we can get to that now.
[CUSTOMER][NEUTRAL] Yeah, I submitted it. Yeah, I submitted it last week. I was, I was wanted to make sure it's in process or something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we did receive it, processed it on the [PII] and.
[AGENT][NEUTRAL] It says.
[AGENT][NEUTRAL] Covered outpatient services are hospital emergency room, outpatient surgery in a hospital or an inpatient surgery center, diagnostic testing in a hospital or an MRII facility. There was no payment made. What was the services done?
[CUSTOMER][NEUTRAL] Uh, it was just like, um.
[CUSTOMER][NEUTRAL] You say when?
[AGENT][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Where it was at um.
[CUSTOMER][NEUTRAL] I can't think of their name right now, uh, but it was like my primary or who I go to to just do like my monthly, I mean my yearly stuff.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it's the charges that we received are from an independent laboratory, uh, which are not covered under your policy.
[AGENT][NEUTRAL] From Laborp of America.
[AGENT][NEUTRAL] And so no payment was made, yeah, independent labs are not covered, so let's say if the lab was done.
[CUSTOMER][NEUTRAL] OK, because it was a.
[AGENT][NEUTRAL] Uh, like in a hospital setting, um, you do have the outpatient facility benefit, um, it could have been considered under that benefit, but it, when it, when the claim comes from an independent lab like Quest Diagnostics or LabCorp of America, you do not, your policy does not have that lab writer.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But yeah, it's, it's, it's uh.
[CUSTOMER][NEUTRAL] The lab is at the doctor's office. I go to. It's not like I'll leave there and go somewhere else. I just go from one room to another and they do my blood work.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I think what they did was sent the blood work.
[AGENT][NEUTRAL] To lab core to be read.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this charges from Labor.
[AGENT][NEUTRAL] This claim is from Labor, let me see.
[CUSTOMER][NEUTRAL] And you would, so what you just need the name, the name of the hospital or the name of the place.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Was that done on, was it several dates that you said?
[AGENT][NEUTRAL] She was
[CUSTOMER][NEUTRAL] Yeah, it's it's called Jessie Choice Community Health Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see another claim for from [PII], and this would be for your office visit.
[AGENT][NEUTRAL] And so it looks like the total payment on this check was $50 also processed on the [PII].
[AGENT][NEUTRAL] Um, and then it looks like there were 2 office visits, office visits here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, paid at $25 each.
[AGENT][NEUTRAL] So the check amount is for 50.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Which is the maximum benefit for an office visit.
[AGENT][NEUTRAL] And so the check would have been mailed yesterday.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To the address that you verified, uh huh, for the office visit.
[CUSTOMER][NEUTRAL] Oh so they mailed the check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cool. I, I just wanted to make sure it's in process. I didn't know it was done already, OK.
[AGENT][NEUTRAL] Yeah, it's processed.
[CUSTOMER][POSITIVE] Alright well I appreciate your help.
[AGENT][POSITIVE] Oh, you're welcome. Anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, no, just give me back my 20 years and um.
[AGENT][NEUTRAL] I know what I did. It now says 86 instead of 66.
[CUSTOMER][NEUTRAL] We got to go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Correct.