AccountId: 011433970860
ContactId: 88a8f6b7-8e20-44e7-93ff-385bc2cf9ef5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296600 ms
Total Talk Time (AGENT): 141930 ms
Total Talk Time (CUSTOMER): 90229 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/88a8f6b7-8e20-44e7-93ff-385bc2cf9ef5_20250224T19:35_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling the APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], how are you doing? My name is [PII]. Uh, let me give you my policy number, I guess you need.
[CUSTOMER][NEUTRAL] Or a group number?
[AGENT][POSITIVE] That would be great. If you have that policy certificate number would be great.
[CUSTOMER][NEUTRAL] Which one?
[CUSTOMER][NEUTRAL] 02555995
[AGENT][NEUTRAL] Thank you. And Mr. [PII], can you verify your date of birth and current mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The turmer
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright thank you and what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, and can you verify your Yahoo email, please, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you, sir. I appreciate that verification. We just try to protect your information. And how can I help you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How can you help me? Well, I was denied a payment on a claim.
[CUSTOMER][NEUTRAL] Meaning that they called up to see if you would pick up the copay of an MRI.
[CUSTOMER][NEGATIVE] And you guys denied it and I want to know why.
[AGENT][NEUTRAL] I'm checking on that. So, diagnostic testing is covered.
[AGENT][NEUTRAL] Bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And they said they called and said it was not covered.
[CUSTOMER][NEUTRAL] They said they, they, they I guess they sent an email or something like that. I don't know exactly how they do it because it's very hard to understand them sometimes, but they said it was for an MRI and do you need the company name that, that may have
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call
[AGENT][NEUTRAL] Uh, no, sir. I see on the [PII] there was a, uh, provider calling for an office visit.
[CUSTOMER][NEUTRAL] Or can you see that?
[AGENT][NEUTRAL] I'm just checking.
[CUSTOMER][NEUTRAL] [PII] was
[AGENT][NEUTRAL] That would have been Friday.
[CUSTOMER][NEUTRAL] OK, and what office was that? Did, does it say?
[AGENT][NEUTRAL] It doesn't say um the provider, the person that called was [PII].
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] But they were just calling about.
[AGENT][NEUTRAL] An office visit.
[AGENT][NEUTRAL] I've got your policy certificate pulled up, so I'm checking. I know diagnostic test, oh, let me ask you, were they gonna do that MRI in the doctor's office? Or is it in a diagnostic center or outpatient hospital?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's just at an uh an MRI center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just not sure.
[CUSTOMER][NEUTRAL] It um
[AGENT][NEUTRAL] Why they would have said that.
[CUSTOMER][NEUTRAL] [PII], it's a Tesla MRI.
[CUSTOMER][NEUTRAL] Implantation
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So your policy does, does cover.
[CUSTOMER][NEUTRAL] Does it give you a
[AGENT][NEUTRAL] And I'm looking at your policy certificate. It says that diagnostic testing performed in a hospital outpatient facility or an MRI facility or a physician's office.
[AGENT][NEUTRAL] And an MRI is definitely diagnostic testing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, let me make some more phone calls. I appreciate your time so it's not you guys that uh.
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] Yeah. Do you know if it was maybe your primary insurance?
[CUSTOMER][NEUTRAL] What do you need?
[CUSTOMER][NEUTRAL] Well, that's what I'm gonna, that's who I'm gonna call up next.
[AGENT][NEUTRAL] Yeah, because we can, we can um process and pay a claim if your primary insurance provides benefits or something towards your deductible or co-insurance. You have a benefit, Mr. [PII], of $7500 that we can pay toward diagnostic testing for the deductible or co-insurance of your primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Got you. Alright, let me, uh, let me make a few more phone calls. I appreciate your time. Thank you so much.
[AGENT][POSITIVE] My pleasure and if they have any questions, please tell them to call us back so we can verify that, OK? All right. Thank you, sir. You have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Bye.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye bye.