AccountId: 011433970860
ContactId: 2e48c79d-bd91-4c11-bc48-80de0513ea8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474519 ms
Total Talk Time (AGENT): 180290 ms
Total Talk Time (CUSTOMER): 264978 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/2e48c79d-bd91-4c11-bc48-80de0513ea8f_20250226T22:36_UTC.wav
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[AGENT][POSITIVE] Good
[CUSTOMER][NEGATIVE] Account fucking money, hello?
[AGENT][NEUTRAL] Yeah, that's
[AGENT][POSITIVE] Yes, sir. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah, I'm calling about a claim that like 3 of them and um he didn't pay anything out of 3 claims, I mean, I, I pay like 45 hours a week.
[CUSTOMER][NEGATIVE] And I've been paying into it for 2.5 months and I went to the doctor's and, and you didn't I paid absolutely nothing, not a thing.
[AGENT][NEUTRAL] OK. Uh, sir, what's your name and the policy number, please, and I can look at the claims.
[CUSTOMER][NEUTRAL] My name is [PII] and my policy number is 02586509.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEGATIVE] I mean, you, well, all the money I paid you, I could have paid that and, and going to dinner 3 or 4 nights a week. I mean, what the heck?
[AGENT][NEUTRAL] OK, and Mr. [PII], verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII]. Oh, that's [PII].
[AGENT][POSITIVE] OK, thank you so much. Uh email.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I see that as a, we have in our system as [PII], is that?
[CUSTOMER][NEUTRAL] Yeah, [PII] too.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Give me one moment, Mr. [PII], look at through your claims.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK, um, I show we received several claims, um,
[CUSTOMER][NEUTRAL] Right, I got 3 of them here in front of me.
[AGENT][NEUTRAL] OK, there is one claim, uh, looks like for data service of [PII]. It looks like for um an office visit.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, that's what they're all for I believe.
[AGENT][NEUTRAL] And that one was processed and paid, um, but the other two, there was one for lab services which are not covered under the plan, and the other processes benefits of max for the data service.
[CUSTOMER][NEGATIVE] I don't understand what that even I, I, I'm looking at something right now. I got 3 pieces of paper.
[CUSTOMER][NEUTRAL] It says um,
[CUSTOMER][NEUTRAL] Uh, patient account claim number, the last one is 765.
[CUSTOMER][NEUTRAL] And total benefits paid 0.
[CUSTOMER][NEUTRAL] I got another one here it says claim number 775.
[CUSTOMER][NEUTRAL] Total benefits paid 0.
[CUSTOMER][NEUTRAL] And I got another one here it says 770 total benefits paid 0.
[AGENT][NEUTRAL] Well, the one for the claim number that ends in 3765 I show that we paid to the provider $150.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other, go ahead.
[CUSTOMER][NEUTRAL] Well, why did you say you paid nothingson?
[AGENT][NEUTRAL] I do not know. And you're looking at an explanation benefits from our company where it shows it paid 0?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me look at this TOB. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me see, check date if it said it has a check date [PII] or [PII]. The claim number, yes, 3563775.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Labor Dallas.
[CUSTOMER][NEUTRAL] And it said.
[AGENT][NEUTRAL] Yeah, that one, that one process is not covered because your policy doesn't cover any lab tests.
[AGENT][NEUTRAL] And the other one.
[CUSTOMER][NEUTRAL] Alright, but you just said that $3775 you paid 100 something dollars on.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] I said the 3563765, we paid 150.
[CUSTOMER][NEUTRAL] 3653765. OK, alright, yeah, that's the right, this one is, uh, to the doctor's office uh accident 6 treatment at the 6 treatment no coverage proceeding right, um.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, and it still says uh total benefits paid 0.
[AGENT][NEUTRAL] Uh, you should receive another email or another EOB because it looks like uh we received a claim and initially it was pending eligibility information which was received and so we were able to release that claim and paid $150.
[CUSTOMER][NEUTRAL] Because I had the wrong one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, well, I mean, that's, um, that's fine. I mean, I just like, because I, I got the best package that was offered and then I'm like I go to the doctor one time and it's like they paid nothing so I was like a little unhappy. So, but yeah, I mean if you picked up some of it, if you picked up like that, that part of it, I mean I don't understand some things aren't covered like a lot of things, but.
[AGENT][NEUTRAL] No, I understand.
[CUSTOMER][POSITIVE] Yeah, I'm alright, I'm happy I guess now.
[AGENT][NEUTRAL] OK. Well, um, have you set a
[CUSTOMER][NEGATIVE] I just, I was like, you know, if I'm gonna be paying all this and not getting nothing out of it, I was gonna see how I could get out of this, but OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I understand, but um have you set up on our online service center to be able to view your policy and it shows what benefits are covered?
[CUSTOMER][NEUTRAL] No, I have not
[CUSTOMER][NEUTRAL] I, my, I didn't really get a whole lot of information. I, I got this kind of through a temp service and you know the job and work for and I figured, well, yeah, I wouldn't mind having some insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I really haven't received a whole lot of information. I mean, if I had some mails I never got it. I never received it. So yeah, if you could tell me how to like log in or create this, that would be great or where to even start.
[AGENT][NEUTRAL] Yes, sir. I can assist you with that. Um, if you go to the [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] AM
[AGENT][NEUTRAL] AM, yes, sir. [PII].
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you go on to the site, uh, select new user and then individual.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they'll ask for your name, date of birth, social, zip code and email address. And once you've entered that information, you'll be able to set up a username and password, and you'll be able to view your policy and check claim status or print out a temporary card if you need to.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK. So then I can, I got the cards.
[AGENT][NEUTRAL] No, I'm just saying let's, yeah.
[CUSTOMER][POSITIVE] But yes, so now I, I know what I, I can know what to expect and I like get a bill. I don't have to like increase my blood pressure or call you and cry anymore, so that'll work.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, if you need to call, you can call us. Uh, we're here till [PII] Central Standard Time. But yes, sir.
[CUSTOMER][POSITIVE] OK. Well, thank you very much. I appreciate you explaining to me and giving me a way to find out more about what I got, so I appreciate it.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL. You have a great day, Mr. [PII].
[CUSTOMER][POSITIVE] You too, thank you very much bye.
[AGENT][POSITIVE] Thank you. Bye.