AccountId: 011433970860
ContactId: 59bdbfc3-e1b4-4379-a3c4-6cc393f4e54d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326440 ms
Total Talk Time (AGENT): 65931 ms
Total Talk Time (CUSTOMER): 137163 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/59bdbfc3-e1b4-4379-a3c4-6cc393f4e54d_20250512T17:55_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling because um I had a couple of questions about a claim that I sent in and I don't know if it was denied um if you can assist me with that please.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Um, policy number.
[CUSTOMER][NEUTRAL] I have a group number and uh.
[AGENT][NEUTRAL] Inpatient outpatients?
[CUSTOMER][NEUTRAL] 2 certificate numbers.
[AGENT][NEUTRAL] Yes, ma'am, one of those.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, all right, inpatient is 141.
[CUSTOMER][NEUTRAL] 8061, M as in Mary, L as in Larry, and the number 7.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And may I ask who's calling?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Sure, sure, it's [PII]. The email is [PII].
[AGENT][POSITIVE] Thank you, Miss [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you had a question on some claims that you sent in.
[CUSTOMER][NEGATIVE] Yeah, they were, they're actually the same claim, and the first time I sent them in, and then I saw that there was 0, and then the second time I sent it in with new information with the diagnosis codes and all that stuff, and then I got a letter in the mail stating that, you know, it looked like my claim wasn't paid and it says here that policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Um, but I had actually made an appointment just to go in for a cough. So I would thought that would qualify as a sickness cause I had like this lingering cough, you know, and I was given like antibiotics and all that stuff. And, you know, whilst I was there, they did some other things, but the initial reason for my visit was because of the cough. So I thought that that was
[AGENT][NEUTRAL] OK, I can look
[AGENT][NEUTRAL] I can look that up for you. What data service?
[CUSTOMER][NEUTRAL] Go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] Um, the date of the service.
[CUSTOMER][NEUTRAL] was [PII].
[AGENT][NEUTRAL] OK, the procedure code that we have is just for a wellness.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure why because.
[CUSTOMER][NEUTRAL] If it was a wellness, I guess I, I'll have, because I was charged for the visit. Normally a wellness is free, um, but I was charged like $60 for.
[CUSTOMER][NEUTRAL] The, um, the visit.
[AGENT][NEUTRAL] Yes, ma'am. I would call them and ask them about, uh, the, let me see the diagnosis. Hold on one moment.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up the claim, just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it was on your, uh, explanation of benefits. The diagnosis was for wellness from your, uh, major medical insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Alright, I'll give them a call then to find out why they did it as that and then charged me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][POSITIVE] OK, alright, thank you again for your assistance.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, that would be it.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.