AccountId: 011433970860
ContactId: 582c8cce-0d07-4eea-9003-d0afc1d1d17f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326239 ms
Total Talk Time (AGENT): 81224 ms
Total Talk Time (CUSTOMER): 171090 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/582c8cce-0d07-4eea-9003-d0afc1d1d17f_20250127T16:30_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], how are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm just reaching out to figure out a recent um visit that I had to urgent care and figure out uh my coverage and
[CUSTOMER][NEUTRAL] Um, how to go about it basically just making sure, um, that, uh, everything was like presented, uh, on your end the proper way and I went about the right way, but, um, basically, so I went to urgent care, uh, because I had kind of like a wrist injury and um.
[CUSTOMER][NEUTRAL] I put in my information wasn't exactly sure if it was like the correct new information for my um plan uh they were saying it was like older information but I called um I called you guys and I just like kind of uh reaffirmed and I called them and, and hopefully, hopefully everything is uh.
[CUSTOMER][NEUTRAL] You know, on both sides what they need, but I got a bill in the mail and it, uh, it said that my coverage didn't cover anything, so I'm, uh, I don't know, I just wanted to call you and see like if I did everything the correct way or you know what's going on with it, but.
[AGENT][NEUTRAL] OK. And um
[AGENT][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right. OK. And what's your policy number, [PII]?
[CUSTOMER][NEUTRAL] As it is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02299380
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Right, and verify your date of birth and mailing address for me.
[CUSTOMER][NEUTRAL] [PII], um [PII].
[AGENT][NEUTRAL] And what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you for that information.
[AGENT][NEUTRAL] And so is this a claim? Let's see.
[AGENT][NEUTRAL] What was the date of service of the urgent care visit?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It was November, um, I think like mid November.
[AGENT][NEUTRAL] Like the [PII]?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] That's probably right, yeah.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so it looks like the claim was processed on the [PII].
[AGENT][NEUTRAL] Um, and we issued a payment of $75. That was the maximum benefit for that type of service.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] was $75 and that went to Georgia Primary Care Partners.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm like looking, did you see, did it say what the total bill was?
[AGENT][NEUTRAL] Um, it doesn't. It says that the office visit fee was 393, and then did you have like an X-ray or something done?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, and so then the charge for the X-ray was $83.
[CUSTOMER][NEUTRAL] OK, on top of 393?
[AGENT][NEUTRAL] Right, the, the 393 was for the, the physicians charge the office visit fee charge.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] And then the $83 was for the X-ray?
[CUSTOMER][NEUTRAL] OK, so it'd be.
[CUSTOMER][NEUTRAL] OK, so it would be that the office is a charge plus the X-ray minus $75 is what you cover.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK, yeah, I didn't realize my coverage was that small, so, OK, so they sent me a bill for 393, which is I guess.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Less than it should be, but.
[AGENT][NEUTRAL] Yeah, that was a chart
[AGENT][NEUTRAL] Yeah, that, that was a charge for the office visit?
[CUSTOMER][NEUTRAL] OK, so they're just not charging me for the X-ray, I guess.
[CUSTOMER][NEUTRAL] And maybe they're just rounding down or something since you covered $6 less than the X-ray or something. I don't know. OK, got you. So everything checks out I guess.
[AGENT][NEUTRAL] OK. And did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, no, I think I'm good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you I appreciate the help.
[AGENT][POSITIVE] Yeah, you're welcome, [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye.