AccountId: 011433970860
ContactId: 50231c48-4c61-4161-a1c2-b3e7ecdcdf4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265559 ms
Total Talk Time (AGENT): 134546 ms
Total Talk Time (CUSTOMER): 95462 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/50231c48-4c61-4161-a1c2-b3e7ecdcdf4f_20250130T15:13_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I was calling from Lexington Medical Center.
[CUSTOMER][NEUTRAL] I was trying to find out if you could provide claim status for me, but as I was listening to the options, do you all cover medical or is it just.
[CUSTOMER][NEUTRAL] Dental and the other ones listed.
[AGENT][NEUTRAL] Did it now when, when I ask you this, I'm not getting smart. So medical is medical all around. So I have to look at the member's policy to verify what's covered.
[CUSTOMER][NEUTRAL] Like an office visit, yeah.
[CUSTOMER][NEUTRAL] Right, well, let me say.
[CUSTOMER][NEUTRAL] OK, no, I got what you're saying. I wouldn't have took it that way because I wasn't clear with what I said.
[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] Could I get your callback number and the policy number?
[CUSTOMER][NEUTRAL] I guess I'm saying office visit.
[CUSTOMER][NEUTRAL] Yeah, the policy number?
[AGENT][NEUTRAL] Yep, what's your call back number just in case the call is disconnected please? Mhm.
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Oh, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's the policy number of that member?
[CUSTOMER][NEUTRAL] 2,323,630
[AGENT][NEUTRAL] Thank you, [PII]. What's the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in regards to claim status for what date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $240.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], so the office visits are not covered. So it's not, so all of our policies don't have the office visits are not covered. However, some of the policies do, but let me verify her benefits 9751.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me give you the claim number.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] All right. I'm ready when you are.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Look, you waiting on me. OK, so it's 343 9.
[AGENT][NEUTRAL] 751 that's 343-9751 it was processed [PII]. Well, it was sent in [PII] it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let's see they say in [PII].
[AGENT][NEUTRAL] So now let me see.
[AGENT][NEUTRAL] And her benefits, [PII], well, her policy is terminated now has been since [PII], but when she did have a policy, her benefits had
[AGENT][NEUTRAL] Inpatient services of $300,000 per calendar year. She had outpatient benefits of $3000 per calendar year.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] She had the
[AGENT][NEUTRAL] Treatment rider.
[AGENT][NEUTRAL] So she didn't have office visits. She didn't have office visits or the treatment received in the office covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] OK. Thank you. Can you spell your name for me?
[AGENT][NEUTRAL] She only had inpatient and outpatient services. Of course, [PII], and I need you to spell yours as well.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. What was it pronounce your name?
[CUSTOMER][NEUTRAL] [PII], it's, you can just say, so it's [PII], but I guess for people I just break it and say [PII] so.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Do you all get reference numbers?
[AGENT][NEUTRAL] Unfortunately we don't, but you can use my name and today's date as a reference.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Alright, thank you so much I really appreciate your time.
[AGENT][NEUTRAL] Ms. [PII], could you give me that policy number for that member again?
[CUSTOMER][NEUTRAL] Yeah, it's um 232.
[CUSTOMER][NEUTRAL] 3630.
[AGENT][NEUTRAL] OK, that is right, [PII]. That was right. I don't know. I'm tripping. Where are you guys located?
[CUSTOMER][NEUTRAL] Yeah, what's
[CUSTOMER][NEUTRAL] We're in [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Well, it was a pleasure speaking with you. Thanks for calling APL and you have a great day and be safe.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.