AccountId: 011433970860
ContactId: 38752c11-102c-4a93-95d8-3a1a56c42f8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501630 ms
Total Talk Time (AGENT): 221103 ms
Total Talk Time (CUSTOMER): 149436 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/38752c11-102c-4a93-95d8-3a1a56c42f8d_20250116T16:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Hi, my name is [PII] and I've got a question on a bill that I received that they're saying that you guys didn't cover anything.
[AGENT][NEUTRAL] OK, I can check on it for you, Ms. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] 01457233.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. May I have um your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, birthday is [PII].
[CUSTOMER][NEUTRAL] Uh, email is [PII], and what was the other?
[AGENT][NEUTRAL] The address, the mailing address.
[CUSTOMER][NEUTRAL] Mailing is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you too. Alright, and what is the date of service for the claim?
[CUSTOMER][NEGATIVE] Um, well, I had it on the email but I had, I had cataract surgery, um, twice last year for one eye in March and one eye in April, and they're sending me a bill saying that you guys didn't cover any of it, and I'm just checking on it.
[AGENT][NEUTRAL] Was the surgery taking place in an office setting or outpatient surgical center?
[CUSTOMER][NEUTRAL] Out outpatient.
[AGENT][NEUTRAL] Surgery, OK.
[AGENT][NEUTRAL] And you said that you don't know the date of service?
[CUSTOMER][NEUTRAL] Um march.
[CUSTOMER][NEUTRAL] One was in March and then the other was in April.
[CUSTOMER][NEUTRAL] Probably like the [PII] and March maybe around the [PII] or something.
[AGENT][NEUTRAL] OK, let me pull the claims that I got for [PII]. OK, give me one moment.
[CUSTOMER][NEUTRAL] I'm trying to find it here too.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, no, it just.
[CUSTOMER][NEUTRAL] Says the amount it doesn't have a date that it.
[CUSTOMER][NEUTRAL] Took place.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, well, one was [PII] and the other was [PII].
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] [PII] and [PII]. OK. So for [PII], um we did send out a benefit of um $1,607.68 for Memorial Surgery Center.
[CUSTOMER][NEUTRAL] OK, so that went to them it didn't go to the eye doctor.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see, we send another payment as well. So let me pull the other one and see who it went to.
[AGENT][NEUTRAL] OK, for that day we have 2 claims. Let's see.
[AGENT][NEUTRAL] OK. So the other payment that we send out on [PII] was for eyecare Associates.
[AGENT][NEUTRAL] For $467.56.
[CUSTOMER][NEUTRAL] OK, so they show me owing 483 78, so I, I don't owe that 483 if you guys sent 4 67 66 to them.
[AGENT][NEUTRAL] Correct, we send 467.56 out of the [PII] that we're charging for [PII].
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, what about the uh [PII] 1?
[AGENT][NEUTRAL] OK, let me check on [PII].
[CUSTOMER][NEUTRAL] Is there a date that you can give me that you sent that to them?
[CUSTOMER][NEUTRAL] So I can call her back?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, we send that payment on the check date was [PII] and it's going to be under check number 2020736.
[AGENT][NEUTRAL] Um, the claim number is 35463992.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 392
[AGENT][NEUTRAL] Yes, 35463992.
[CUSTOMER][NEUTRAL] 82 OK 6392. OK and then let's move on to the [PII] then.
[AGENT][NEUTRAL] Mhm. OK. So for the [PII].
[AGENT][NEUTRAL] Um, OK, let's see.
[AGENT][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] I bet it's probably about the same.
[AGENT][NEUTRAL] Let me see, looks like we covered the part of it. Let me see.
[AGENT][NEUTRAL] What part was this?
[AGENT][NEUTRAL] 47
[AGENT][NEUTRAL] All right. So on this one, for [PII], we send the payment of $424.76. This was for Memorial Surgery Center. So this was for the center, um, and with that payment of 42476 cents off your benefit. So everything that we received after that was not paid.
[CUSTOMER][NEUTRAL] So that was for the Memorial center so you didn't pay anything to the eye doctor on the 4:17 1?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. When, when we received that claim, you already assessed that your benefits, so it was denied.
[CUSTOMER][NEUTRAL] OK, so I'm gonna owe the 483 plus just the difference between that other.
[AGENT][NEUTRAL] Um, for the 417, um, the only amount we pay was the 42476. So it's gonna be the difference between, let me see how much they apply towards the.
[CUSTOMER][NEUTRAL] To, to them.
[CUSTOMER][NEUTRAL] That that was that was the surgery center that wasn't actual eye doctor though, correct?
[AGENT][POSITIVE] Better ma.
[AGENT][NEUTRAL] Correct. That was the surgery center. That was not the eye doctor.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So if this was an eye doctor on this 483-78 then I'll owe that one.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Plus the difference between the 483 and the 467 on the other one.
[AGENT][NEUTRAL] OK, so let's see, so yeah, we picked the, the surgical place with the full amount, so we'll pay that amount. OK, and let me pull the one that we denied, bear with me and see how much we supply on that one.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The other one actually only about 16 to $17.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Alright, so this one.
[AGENT][NEUTRAL] Yeah, the 483 78 was not paid, so that 483 78 is what you need to cover. mhm.
[CUSTOMER][NEUTRAL] OK, and plus the difference of the other amount. OK, I, I was just, I was just double checking on it before I paid them anything, so I'll call them back and give them the case, the, the check number and the claim number, and, and it went out on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yes, for the [PII], yes, correct, yes. Mhm.
[CUSTOMER][NEUTRAL] So they probably
[CUSTOMER][NEUTRAL] OK, so they probably haven't received that yet. OK, well I appreciate your time.
[AGENT][NEUTRAL] You're welcome. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, I don't think so.
[AGENT][POSITIVE] OK, well thank you for calling ATL. Have a good day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.