AccountId: 011433970860
ContactId: 2f08649f-16d5-4d4c-b153-0b8c8757ff2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329820 ms
Total Talk Time (AGENT): 86059 ms
Total Talk Time (CUSTOMER): 157093 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/2f08649f-16d5-4d4c-b153-0b8c8757ff2b_20250602T16:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEGATIVE] Hello, good morning. Well, I'm so upset about uh your uh action and so angry right now. Because I was your, your, uh, what is it? member last year and I had a surgery.
[CUSTOMER][NEGATIVE] And uh I was paying every month on time what I needed to pay to you monthly and your company don't cover my surgery and right now I have a check in my hand for $425. What is it?
[AGENT][NEUTRAL] I'm not sure.
[CUSTOMER][NEGATIVE] Are you kidding on me? Or what, what is it?
[AGENT][NEUTRAL] OK, your name is?
[CUSTOMER][NEUTRAL] [PII] no.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have the policy numbers probably in regards to?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 89
[CUSTOMER][NEUTRAL] 611.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. And verify your date of birth and mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. And what is that check number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Track number is 22046854.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you ma'am. And what was the issue date on that check?
[CUSTOMER][NEUTRAL] Issue date [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, looks like it's for a claim we received for data service of [PII]. Uh, looks like for surgery and anesthesia, 300 for the surgery, 125 for anesthesia charge.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I don't understand why you're paying 300 for the surgery and 125 for anesthesia?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I need to pay all of the 11,000?
[AGENT][NEUTRAL] Well, under your policy,
[CUSTOMER][NEUTRAL] You say that I need to pay the 11,000?
[AGENT][NEUTRAL] No, I'm not telling you what you need to pay. I'm just telling you how the claim was processed and what we paid, but under your policy for surgery, it paid, give me a moment.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, the max payable for surgery is the 300 and then for anesthesia, um,
[AGENT][NEUTRAL] Let me pull that up and see on the plan.
[AGENT][NEUTRAL] Give me one moment please.
[CUSTOMER][NEGATIVE] I have for Anastasia $125. This are you kidding? This is a bullshit or what is called? You're telling me that you will pay $300 for surgery and $125 for anesthesia. What I need to pay $11,000 rest $11,000. I need to pay. You say that why you pay this to me?
[AGENT][NEUTRAL] Ma'am, we don't tell people how much you have to pay. We can only verify.
[CUSTOMER][NEGATIVE] What to, what to tell him that listen to me, please. No, no, no, listen to, listen to me, please listen to me please when I made this issue, this insurance I was last year I was looking for health insurance and I was told that this is health insurance.
[AGENT][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] Because of this, I sign in for that. If it's not health insurance, why is it in the market as a health insurance?
[CUSTOMER][NEGATIVE] I will sue you for the fraud information. I will sue you. I will take that money. As you, you will pay to 11,000 to the hospital. I know don't need any money. I need to, you pay to the hospital.
[CUSTOMER][NEGATIVE] I will show you what is this? You cheating on me? I'm waiting 1 year, almost 4, so you send me the freaking $400.
[CUSTOMER][NEUTRAL] How do you treat your clients?
[AGENT][NEUTRAL] Well, that's the benefits that's listed under your policy, the max payable for surgery. OK. Is there anything else, Ms. [PII], I can assist you with today?
[CUSTOMER][NEGATIVE] I'm not here. I will sue you. I will sue you. I will sue you. In important, exactly, I will do that.
[AGENT][NEUTRAL] OK.