AccountId: 011433970860
ContactId: 3525935e-34e7-4380-88ae-147e90667621
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627539 ms
Total Talk Time (AGENT): 227953 ms
Total Talk Time (CUSTOMER): 246574 ms
Interruptions: 4
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/3525935e-34e7-4380-88ae-147e90667621_20250307T16:25_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. I, um, I'm just calling because a payment I made for, uh, the other, um, doctor Wait.
[AGENT][NEUTRAL] A claim? You're calling about a claim?
[CUSTOMER][NEGATIVE] A a payment, the doctor didn't receive the payment. I went to they didn't pay for me. I don't know why.
[AGENT][NEUTRAL] May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] is [PII]
[CUSTOMER][NEUTRAL] Um, [PII], my number is [PII].
[AGENT][NEUTRAL] OK, and do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Policy number, uh have the policy number with me right now.
[CUSTOMER][NEUTRAL] I don't know. I see a book. I don't know if it has my book.
[CUSTOMER][NEGATIVE] This is not it.
[CUSTOMER][NEUTRAL] Just, you want my social.
[AGENT][NEUTRAL] Give me just a second. I can't let me go on another system for that.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, may I have your mailing address and email address on file for verification?
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII], the email is [PII].
[AGENT][NEUTRAL] OK, what's
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, and this is for dental or medical?
[CUSTOMER][NEUTRAL] Medical, yeah? Medical.
[AGENT][NEUTRAL] Medical? OK. um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII] I tell you when I tell you the date why didn't didn't be [PII].
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] I don't know. I, I think it's [PII]. I went to see the doctor.
[AGENT][NEUTRAL] the [PII]. OK, let me see if we received that claim. One moment.
[CUSTOMER][NEGATIVE] I feel not that cool.
[CUSTOMER][NEUTRAL] I think that I'm already but the little piece.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And what's the name of the facility?
[CUSTOMER][NEUTRAL] Right now again, um, for the, for the doctor. Doctor [PII].
[AGENT][NEUTRAL] Gordy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, uh, how much is the charge amount?
[CUSTOMER][NEUTRAL] I think it's a um.
[CUSTOMER][NEUTRAL] The, I, I get it, but I gotta go inbox to my email.
[CUSTOMER][NEUTRAL] Uh, you don't, you don't see it there?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm trying to locate it. I haven't pulled one for Doctor [PII] with me. OK, I think I found it. Let me pull this 11 moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK. So it looks that by the time we received this claim, you're already exhausted your benefit and it was not paid.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So actually if you go to the doctor now, is it gonna be covered? Um, so you're gonna pay it or you're not gonna pay it?
[AGENT][NEGATIVE] Now this one, you already used all the benefits for this uh for the last year, so, um, this one was not paid because you already exhausted your benefit. Now it started all over again in [PII] that you can use your benefits in [PII] because it started all over again in [PII], but for [PII], you don't have any more benefits for office visits.
[CUSTOMER][NEUTRAL] How much is it for the year?
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, they only give me a certain amount that's why.
[AGENT][NEUTRAL] Let me check on that. One moment.
[CUSTOMER][NEUTRAL] So it's a new year now you get a new, a new amount.
[AGENT][NEUTRAL] It's gonna be, and this is not a guarantee of payment, just a verification of coverage. You have 6 visits per year at $75 per visit.
[CUSTOMER][NEUTRAL] OK, I got another bill it is um.
[CUSTOMER][NEUTRAL] But then [PII].
[CUSTOMER][NEUTRAL] I think when I went to see them people last year or this year?
[CUSTOMER][NEGATIVE] I can't see. What's the name on it? It, it says this is a death.
[CUSTOMER][NEUTRAL] This is the day to send the bill.
[CUSTOMER][NEUTRAL] Maybe they're
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] 468 for what?
[AGENT][NEUTRAL] Mr. [PII], if you want to go to our website and register, you'll be able to see everything that we have received, what we have paid and what we have not. Um, do you need the website to register?
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] I see you soon.
[CUSTOMER][NEGATIVE] No, it's OK. No, you want it, but you said that this one and this one goes to Dr. [PII] in this bill then I. Oh, I got another bill. I don't know if this one cover to. It's vulture V I R T U A S V I R.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] T U A
[CUSTOMER][NEUTRAL] Can you check for me?
[AGENT][NEUTRAL] Virtual. It's the same date?
[CUSTOMER][NEUTRAL] No, this one is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Yes, the [PII]. Yes, I do see that. Yeah, I see that one as well. I received, we received both of them, but both of them were denied for the same reason. You're already saw that your benefit for [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] So, so it's 6 visits a year you covered for, but you only cover 75 per visit.
[AGENT][NEUTRAL] Correct, yes, this is a limited policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So if it was $75 it would have been covered? Is that what you're saying?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh. Now, is any of his labs covered?
[AGENT][NEUTRAL] Um, let me check the benefits on this one and see if it covers that. And um, Mr. [PII], it's OK if I give this information to the lady on the phone? I'm not, OK, OK.
[CUSTOMER][POSITIVE] Is labs covered under his house.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah.
[AGENT][NEUTRAL] Alright, bear with me just a second.
[CUSTOMER][NEUTRAL] 6 visits a year, um, so I got to change it.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So um all the money will be taken from me insurance.
[AGENT][NEUTRAL] OK, and this is just a one-time authorization to release information to, to you, OK?
[CUSTOMER][NEUTRAL] Every week?
[CUSTOMER][NEUTRAL] My I.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEGATIVE] No, labs are not covered.
[AGENT][NEUTRAL] Unless they're for routine like regular check like um preventative wellness, then yes, um there is some lab work for wellness, but not for regular lab work for sickness.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] So how much is his um premiums every week for his insurance, the $180 total?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This one in particular is handled by Universal Trucking. So that question is more for universal trucking because we don't know if he gets like any discounts applied through universal trucking, so yeah, we don't have the premium here.
[CUSTOMER][NEUTRAL] Yeah, that's.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEGATIVE] OK, I'm just wondering if it was like it doesn't seem like it's worth having it if he's gonna keep being denied coverage for all the bills are just piling up and he's paying insurance. It doesn't make sense.
[AGENT][NEUTRAL] I understand. Yeah, this one is a limited policy. Um, it is not a major medical. It is a limited policy and again, if you need the website to register, it's [PII]. Again, that's [PII], where Mr. [PII] can create an account and you'll be able to see all his benefit, how much it pays, how it pays, and um you can understand a little bit more about how it works, OK?
[CUSTOMER][POSITIVE] You know, thank, thank you very much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you very much.
[AGENT][POSITIVE] You're welcome. No problem. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, no, that's it, thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APR.
[CUSTOMER][NEUTRAL] Oh