AccountId: 011433970860
ContactId: 1e3cd6e1-29a5-4ec3-8294-c4ea3c4b714a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294399 ms
Total Talk Time (AGENT): 129668 ms
Total Talk Time (CUSTOMER): 134979 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/1e3cd6e1-29a5-4ec3-8294-c4ea3c4b714a_20250527T21:35_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I recently had uh imaging done, like a sonogram.
[CUSTOMER][NEUTRAL] And it said that my insurance didn't cover that and they told the company that it was only uh vision and something else dental and vision in which I don't just have dental and vision, so I just wanted to double check with you guys and make sure that.
[CUSTOMER][NEGATIVE] That that was a mistake and that y'all could rerun the claim.
[AGENT][NEUTRAL] Sure, OK, yeah, we can take and see, uh, oh, excuse me, take a look and see what kind of policies you have with us. Um, we don't offer vision, we do offer dental, but we do also offer um some medical policies, so we'll take a look at that. Um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] I definitely have a med, I definitely have a medical policy, so that was very weird. It is [PII]
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have your uh policy number or a policy number with us?
[CUSTOMER][NEUTRAL] I have the medical ID, is that what you need?
[AGENT][NEUTRAL] Sure, uh, we can see if that works.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or what? Oh, I see the policy er number. Is that what you need?
[AGENT][NEUTRAL] OK, uh, we'll see. You just go ahead and give it up.
[CUSTOMER][NEUTRAL] It's 0
[CUSTOMER][NEUTRAL] I don't know. I don't know. There's so many numbers on here and every, every request doesn't match what's on the card. Um, 02585552 is the policy certification number.
[AGENT][POSITIVE] That's OK, it's OK, no worries.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the medical ID is [PII].
[AGENT][NEUTRAL] OK, I'm sorry, you said that policy number that was 025855552?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] All right, and I'm just gonna verify some information really quick. [PII], uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address that we've got on file for you. Uh, looks like it is an iCloud account.
[CUSTOMER][NEUTRAL] It oh [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Awesome, got it thank you so much for verifying that. OK, yes, so this is a limited indemnity medical plan uh so give me just a minute let me see if we did in fact receive this claim. Do you happen to remember that date of service?
[CUSTOMER][NEUTRAL] I can look it up. I can look it up real quick.
[AGENT][NEUTRAL] OK, sure.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like [PII].
[AGENT][NEUTRAL] [PII], let's see.
[CUSTOMER][NEUTRAL] I hope that's correct. They changed the date on me several times, but around that time.
[AGENT][NEUTRAL] That's OK. Let's see.
[AGENT][NEUTRAL] Is this uh Health Imaging Partners?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It was in Vision Imaging in [PII], so that's what, yeah, that's probably it. I don't know who's the main company.
[AGENT][NEUTRAL] OK, this is the only claim that I have for that data service so let's take a look. It sounds right.
[CUSTOMER][NEUTRAL] Um, I did 2 in 1 day, so I paid for the mammogram.
[AGENT][NEUTRAL] I do see that.
[AGENT][POSITIVE] OK, yes, so that, that sounds right.
[CUSTOMER][NEUTRAL] Yeah, and then I had a sonogram, yeah.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim and we were unable to pay a benefit as this states that the calendar year maximum for the wellness benefit had been met for this calendar year. So this policy again as it's a limited indemnity medical plan, it is very of course limited as to what is and is not covered, um, and if you need a copy of your policy, I can have that sent to you, but it just looks like we had already paid a benefit for that previously and I had met its max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Well, great, that's a $2000 bill. Awesome.
[AGENT][NEUTRAL] I'm so sorry. I know I hate being in the bad news like that.
[CUSTOMER][NEUTRAL] I know, I know it's nice to have company insurance, but it also sucks at the same time. It doesn't cover anything.
[AGENT][POSITIVE] I completely understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much.
[AGENT][NEUTRAL] So, is there anything else I can help you with [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, that's it thank you bye bye.
[AGENT][POSITIVE] All righty. Yes, ma'am. Thank you. Bye-bye.