AccountId: 011433970860
ContactId: 6f39f6b9-c6f9-42a6-9202-7ba6f58405b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498339 ms
Total Talk Time (AGENT): 134820 ms
Total Talk Time (CUSTOMER): 223478 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/6f39f6b9-c6f9-42a6-9202-7ba6f58405b0_20250331T18:05_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]. You're speaking with [PII]. OK. Um, I need to know what's going on with um
[CUSTOMER][NEUTRAL] A claim on my policy. Um, I, we, I, I actually, um, put in a, a claim, um, I'm not too sure what was the date, um, in regards to a bill, um, for medical imaging in [PII], um, that was taking place on [PII], OK, um.
[CUSTOMER][NEGATIVE] I just need to know because the due date that I have on this bill, it's [PII] and it's coming up and you know in about a week and I'm supposed to pay a um I'm a huge amount of money.
[CUSTOMER][NEUTRAL] Um, $2,753 would like it if possible if it can be chopped in half if possible, or, you know, I, I'm, I'm as much as possible. I'd just like to know, um, is, is there any progress on the claim and what is the progress and.
[CUSTOMER][POSITIVE] Yeah, if you could give me any information that I need to know, that would be good.
[AGENT][POSITIVE] OK, yeah, I'm happy to check on a claim for you. Do you have the claim number or your policy number?
[CUSTOMER][NEUTRAL] Um, the claim number, I, I got a, um, letter from APL saying that we received the claim on your policy and a review of the claim has started that was [PII]. It was sent [PII]. That was the that's the date on the letter. OK, the, um, I can give you the account number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] The policy number works, yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, what is the policy number?
[CUSTOMER][NEUTRAL] Um, um, I just have the account number. I don't think I have the policy number.
[AGENT][NEUTRAL] What's the account number you have?
[CUSTOMER][NEUTRAL] OK, the account number on the medical imaging uh bill is R22644849081324.
[AGENT][NEUTRAL] OK, that sounds like that's their account number for their uh billing. Uh, what, what is your last name, [PII]?
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Uh my last name is [PII]
[AGENT][NEUTRAL] And you're the policy holder on it, [PII]?
[CUSTOMER][NEUTRAL] Um, yes, that was in the old insurance that I have PHCS. I don't have that insurance anymore. That was from [PII]. I don't remember the exact date and then I changed it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just gonna try and search for your policy by name, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And first name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the last name is [PII].
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] H E R
[CUSTOMER][NEUTRAL] A K E R A K E R.
[AGENT][NEUTRAL] [PII] I got you. OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You.
[AGENT][NEUTRAL] What state do you live in, [PII]?
[CUSTOMER][NEUTRAL] I live in [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Ton of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I believe I've located you. Can I verify please your date of birth and then the address there in [PII].
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the address is [PII].
[CUSTOMER][NEUTRAL] River Crossing way.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me see what I've got on here.
[AGENT][NEUTRAL] OK, so I do see one claim on here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so it looks like um it was for medical imaging of [PII], so it looks like that's the one in question here, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim itself is showing that it was denied. It's showing the denial reason as, um, it's not covered under your plan. It says benefits payable under the certificate are only those outlined in the benefits. This is not a covered expense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that, that was PHCS that was PHCS, right?
[CUSTOMER][NEUTRAL] The the PHCS that I had in November.
[AGENT][NEUTRAL] Uh, this was for, let me see what the date was. One moment.
[AGENT][NEUTRAL] The the date of service is from [PII] if that's what you're asking.
[CUSTOMER][NEUTRAL] Yes, so, OK, so the, um, so the claim was denied, so that means that I have to pay the amount due, which is $2,753 is that correct?
[AGENT][NEUTRAL] If they're billing you for the full amount then yeah that would be something that you would have to talk with them in regards to.
[CUSTOMER][NEUTRAL] OK, so, so that's something that I have to do because you cannot do anything else. It, it, you know, it says that it's been denied, so I have to pay that amount then, right?
[AGENT][NEGATIVE] It looks like the correct, the procedures that were submitted to us were denied because they weren't covered on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Alright, OK, so, so I, I will pay it, yeah, I'm, I'm not glad I don't have that insurance anymore, you know, I had it for a short time. I should have known better once, once I, you know, went into it, um, OK, so I'll pay it. I have better insurance now. I, you know, I have [PII], so that's a little bit better, so.
[CUSTOMER][POSITIVE] OK. um, thank you so much. So I'll just go ahead and pay the bill then. Thank you.
[AGENT][POSITIVE] OK. You're welcome. Have a nice day, [PII].
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye bye.