AccountId: 011433970860
ContactId: 6b5d0a6f-1b01-4a81-af5c-e707cc285f26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 167330 ms
Total Talk Time (AGENT): 76772 ms
Total Talk Time (CUSTOMER): 58064 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/6b5d0a6f-1b01-4a81-af5c-e707cc285f26_20250529T20:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm with the vata's office. Can you look at a claim with me please?
[AGENT][NEUTRAL] Sure, I can look at that claim for you. uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Alrighty, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number for the member?
[CUSTOMER][NEUTRAL] I'm sorry, my apologies. Yes, 02120671.
[AGENT][POSITIVE] You're OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's [PII] Date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. OK, do you have the claim number that we're supposed to be looking at?
[CUSTOMER][NEUTRAL] I do it's 352-849-93.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so just so that you are aware, um, before I go into this, that this is a limited indemnity medical plan. So of course it is limited as to what is and is not covered, uh, pays a set dollar amount per covered procedure or office visit. So what I'm seeing here for this claim is, excuse me, mine, it's my turn now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The outpatient treatment due to a sickness is not covered under this policy. So it simply looks like this is something that's not going to be covered.
[CUSTOMER][NEUTRAL] OK, it was like it was a um office visit uh for whatever reason, so this is, it's not covered correct?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, well I didn't see any reason on the EOB. I'm like, let me give him a call. Maybe the other half got lost or something.
[AGENT][NEUTRAL] Yeah, sometimes they're a bit vague.
[AGENT][NEUTRAL] Maybe it does happen.
[CUSTOMER][POSITIVE] They are OK, well.
[CUSTOMER][NEUTRAL] Well, can I get a reference number from you please?
[AGENT][NEUTRAL] Sure, it would just be my first name, last initial, and today's dates, and so my name is spelled [PII] is there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all I have. I sure do thank you for looking at this for me. You have a great evening.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Yes ma'am. You too. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes ma'am bye.