AccountId: 011433970860
ContactId: 55e69bbc-ff1a-40d4-814a-56a210f1636f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 773280 ms
Total Talk Time (AGENT): 299613 ms
Total Talk Time (CUSTOMER): 262408 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/55e69bbc-ff1a-40d4-814a-56a210f1636f_20250624T19:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Contacting APO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hi yeah I uh was calling regarding a claim I placed but I'm really I'm having a hard time to understand, um.
[CUSTOMER][NEUTRAL] The explanation of benefits.
[CUSTOMER][NEUTRAL] And uh like who was paid the claim I I really like the website doesn't offer a lot of information.
[AGENT][NEUTRAL] OK, yes, I'd be glad to look up your claim. Uh, what is your policy number, please?
[CUSTOMER][NEUTRAL] Yes, so my policy number is 02345074.
[AGENT][NEUTRAL] Thank you. And if I could just verify your name, and date of birth, and a phone number, please. I just need to make sure I've got the right policy.
[CUSTOMER][NEUTRAL] Yes, so it's [PII] and my uh phone number is [PII].
[CUSTOMER][NEUTRAL] Um, what was the other question?
[AGENT][NEUTRAL] Uh, uh, so you gave me your phone number, so that should be it, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what date of service are we looking for?
[CUSTOMER][NEUTRAL] So, uh,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, say, can you, can't barely hear you. Can you repeat?
[AGENT][NEUTRAL] Uh, yes, what is the date of the service, please?
[CUSTOMER][NEUTRAL] The oh the data service is, um, I think it says [PII].
[AGENT][POSITIVE] OK. Yes, and, and how can I help?
[CUSTOMER][NEUTRAL] Yeah, so basically the claim, so I don't know why my insurance like put everything into one page, but I'm only putting a claim against the um
[CUSTOMER][NEUTRAL] The MRI that I had to pay $366 at the MRI center. I, I wasn't putting a claim on the visits or
[CUSTOMER][NEUTRAL] Because in the remarks says often businesses are not covered by this I wasn't putting a claim on that.
[CUSTOMER][NEUTRAL] Um, it was just only on the MRI, but it says like a similar occurrence was already paid. I've only had one MRI and this, this is it, like I've never had another one in my entire life. So, kind of a little confused.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, sure. So first of all, um, anything that, uh, when, uh, anything that you turn into us.
[AGENT][NEUTRAL] Um, I realized that you, you only wanted to have a focus on the MRI and I do understand that. But anything that, uh, else that we received, um, anything else such as the healthcare imaging, uh, the Doctor [PII], that sort of thing, Quest Diagnostics, we all have, we have to acknowledge it, um, and, uh, and that's why you're, yeah, OK. Now, on your, um, on your, uh,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Explanation of benefits. What we did was we paid $250 and that's the amount that we will pay per occasion for for the diagnosis code. Now in this case.
[CUSTOMER][NEUTRAL] I, that's, uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I can't, I can barely understand it's like I don't know there's like a weird noise, yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I'm sorry. My, yeah, I'm having trouble hearing you as well. I don't know what's wrong with my phone. So what we do is we will pay $250 per occasion and what that means is, is per diagnosis. So, in this case, um, I'm, I'm just looking at this. I'm having a hard time seeing it here. Uh, but it looks like the diagnosis code, um, was, uh, let's see if I've got that. Excuse me just a second. I'm sorry.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] It looks like, uh, I'm, I'm trying to find your diagnosis on here, but it's per diagnosis.
[AGENT][NEUTRAL] So let me just check here really quickly and see if I can't find it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the orbital mass.
[AGENT][NEUTRAL] Yes, OK, and that's it'll pay a total of $250 per, uh, for that, um, that type of, uh, uh, yes, so it looks like a benign neoplasm, uh, yes, and so what we did is we paid a total of $250 for that, which is what your policy is for. Now, anything else that it has that same diagnosis, we will put, um, the, the, the explanation of benefits that will be, well, that's already been paid for this diagnosis. Now that renews every 90 days.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's why that says that, um, so first.
[CUSTOMER][NEUTRAL] Oh, it's like it's something, if let's say I get diagnosed again, let's say next week.
[CUSTOMER][NEUTRAL] Um, it's already covered by this one. That's, that's what you're trying to tell me?
[AGENT][NEUTRAL] That, yeah, that's correct, yes, yes, um, so what we would do is we would go 90 days from [PII].
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] Got it, got it. OK, and so who, who, who got paid those $250?
[AGENT][NEUTRAL] It looks like you do, so let me just, yeah, so it looks like you're um.
[CUSTOMER][NEUTRAL] I did
[CUSTOMER][NEUTRAL] Oh, OK, do you know where?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes, absolutely, um, let me just see if I can't find that, um, uh, see if I can't see that. So it looks like that was that was processed on the [PII] of.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. Now, you have a direct deposit with us, so I would check your bank. You, you have a direct deposit with us, so you should have gotten that $250 directly into your bank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I don't think I would have missed $250. That will reflect loudly on my bank account. OK, so, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, well, I would check it certainly because it looks like we have a direct deposit for you and that's what that's what it what happens. So if you didn't receive that uh payment by now, we do need to know that so that we can cancel that that payment.
[CUSTOMER][NEUTRAL] OK, let me, I'm opening my I'm, yeah, I'm opening my and you you have I think the one the account ending in.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Yeah, I'm, I'm afraid I can't see that. I'm sorry.
[CUSTOMER][NEUTRAL] OK, hold on, so [PII].
[CUSTOMER][NEUTRAL] So around it.
[CUSTOMER][NEUTRAL] Yeah, it's not it's not in my bank account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't use that account so that's why I would know like if something hits that account.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let's see where what the bank account we've got here on on file because we do need to to check that.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, she just.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, there's nothing. Mhm.
[AGENT][NEUTRAL] OK, let me check and see what, what we have on this. Just give me just a moment, please. I'll be right back. Excuse me just one moment, please.
[CUSTOMER][POSITIVE] Yeah, yeah, of course.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Yes, [PII], this is [PII] in the claims department, um.
[AGENT][NEUTRAL] I'm not sure what to tell this lady. She has a direct deposit with us.
[AGENT][NEGATIVE] And we were depositing something on the [PII] of this month, and she says that it's not showing up in her bank.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, and I can't even find, I, I was going through her, um, her documents, and I can't even find where it's, uh, on here, um, where I can find the direct deposit form just to verify the bank that she that she turned in. Um, what do we normally do with something like that? She hasn't, does she need to con contact, I mean, who does she contact? Who, who do I contact to let them know that she hasn't received this direct deposit?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's her policy number?
[AGENT][NEUTRAL] It's 02.
[AGENT][NEUTRAL] 34
[AGENT][NEUTRAL] 5074
[CUSTOMER][NEUTRAL] OK, let me see, so just to make sure I understand um.
[CUSTOMER][NEUTRAL] We were depositing something to her was it it was claims related?
[AGENT][NEUTRAL] Yes, it was claims related, yeah, and it was $250.
[CUSTOMER][NEUTRAL] Right? And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so she's saying that she hasn't gotten that and then and then you're saying that you don't see any direct deposit information?
[AGENT][NEUTRAL] Well, I see it on the, on the um Amtrak uh screen, but I'm, I'm trying to, we, uh what I was trying to do is verify her, her bank account.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, because she said that she's got, you know, and I can't find anything. I thought that they highly printed that to here, but I can't find it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um I don't
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] I can see her bank information on the um PIDAT screen um.
[AGENT][NEUTRAL] OK, what screen is that again? I'm sorry, I apologize. TI.
[CUSTOMER][NEUTRAL] That's OK. [PII]
[AGENT][POSITIVE] Yes. Oh for sure.
[AGENT][NEUTRAL] OK, OK, so let me see if I can't um.
[CUSTOMER][NEUTRAL] And it's at the bottom
[AGENT][NEUTRAL] Yeah, I see that or, uh, is it her bank routing? OK, so what I'll do, I'm sorry, I'm sorry, um, [PII], so what I'll do is I'll go ahead and ask her if that's correct, but if it turns out for whatever reason that that's not right, what, what do I do? I mean, if it is right and she hasn't gotten the money, what does she do?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So if it is right and she hasn't gotten it then what we'll probably have to do is get her information so that we can call her back and we're gonna have to research on our end um I think what we'll probably have to do is um check our banking information um and then we may even have to get her to check her banking information you know while we do that also um she might have to call her bank and see if they can see anything on their side where we tried to deposit something.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, but it'll probably be a situation where we need to research and call her back, um, but definitely verify that, um, account information with her and then, you know, if she's saying that it's correct and still doesn't see that then if you'll get her call back information and put that in through the hub to us then what we can do is reach out um I think what we'll have to do is reach out to finance and.
[CUSTOMER][NEUTRAL] Um, see if we can get some more information on our end to look into it and then we can reach out to her once we have some more information.
[AGENT][POSITIVE] OK, that's great. I appreciate it. Thank you very, very, very, very much, and I'm, I'm sorry, I for I, I look at the screen all the time and I forgot that the bank was on there. OK, so Tuesday, I'm sorry.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] No, that's OK.
[AGENT][POSITIVE] Thank you very much for your help. Thanks.
[CUSTOMER][NEUTRAL] No, it's OK. You're welcome.