AccountId: 011433970860
ContactId: 7521a68d-ff71-4f7d-b71b-ebb95ad93323
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168360 ms
Total Talk Time (AGENT): 57259 ms
Total Talk Time (CUSTOMER): 77997 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/7521a68d-ff71-4f7d-b71b-ebb95ad93323_20250624T19:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, can I give you my policy number, please?
[AGENT][NEUTRAL] Um, well, first, let me get your name and a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] It's more cigarettesy.
[CUSTOMER][NEUTRAL] And the number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Um, now I'll take your policy number.
[CUSTOMER][NEUTRAL] 01960211
[AGENT][NEUTRAL] OK, thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Yes, ma'am. And how can I help you?
[CUSTOMER][NEUTRAL] I have this uh bill date of service from [PII].
[CUSTOMER][NEGATIVE] And um I got the bill from Genesis Care and it was the wrong amount and then my insurance, Imagine 360 said what's payable.
[CUSTOMER][NEUTRAL] But they don't cover it. So then I submitted it to you, right? And then
[CUSTOMER][NEUTRAL] I got the explanation of benefits. So are you saying that this is not payable?
[CUSTOMER][NEGATIVE] Cause it seems like it's not being paid because my insurance paid it even though they didn't pay it. Am I reading this incorrectly?
[AGENT][NEUTRAL] OK. For what claim number?
[CUSTOMER][NEUTRAL] Um, 361-2309.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that the claim, um, part of the claim denied, um, the first line denied because it was for the office visit. And under this policy, um, the co-pay for office visits is not covered. And then the second line denied because your primary insurance paid the second line in full. And the third line that actually paid out.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The third line, the 76,770 for the $438 that paid out, that paid to the provider.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess I owe my co-pay then, which was the $45. OK. All right. I guess I wasn't reading it correctly. OK, thank you for explaining it. I appreciate it.
[AGENT][POSITIVE] Oh, no problem. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Mhm. Thank you, [PII], for calling APL. Have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] You too bye.