AccountId: 011433970860
ContactId: 8b57c625-6d94-48dd-a770-d95b1536c2a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231250 ms
Total Talk Time (AGENT): 72208 ms
Total Talk Time (CUSTOMER): 95740 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/8b57c625-6d94-48dd-a770-d95b1536c2a2_20250411T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] No, I'm on it right now. I don't blame you.
[CUSTOMER][NEUTRAL] Um, yes, this is [PII] with Thanksboro Urgent Care. I have a question about this members, um.
[CUSTOMER][NEUTRAL] Clean
[AGENT][NEUTRAL] OK. Can I get your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do it's uh 02469142.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and what was that claim number?
[CUSTOMER][NEUTRAL] Uh, I don't have a claim number. I have data service [PII].
[AGENT][NEUTRAL] And what were the bill charges?
[CUSTOMER][NEUTRAL] $194.
[AGENT][NEUTRAL] OK, uh, looks like we had denied it for the calendar year max was met.
[CUSTOMER][NEUTRAL] OK, she's arguing that they haven't been to an urgent care 5 times this year.
[AGENT][NEUTRAL] OK, let me see what we've got.
[CUSTOMER][NEUTRAL] And does the is it start [PII]?
[AGENT][NEUTRAL] Uh, yes, um, so let me see what.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, for their urgent care.
[AGENT][NEUTRAL] Um, it looks like they have a $75 per day, a max of 1 day per calendar year per person.
[AGENT][NEUTRAL] Um, I don't know if maybe she's getting it confused with the physician's office. That's a max of 6 days.
[AGENT][NEUTRAL] But specifically urgent care is just one day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What do you mean it's just one day? She only gets one visit per calendar year at an urgent care?
[AGENT][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh she only gets only.
[CUSTOMER][NEUTRAL] Get one visit at an urgent care per calendar year.
[AGENT][NEUTRAL] Yeah, this is a
[CUSTOMER][NEUTRAL] But for her primary
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] But her for primary care she gets 5 visits.
[AGENT][NEUTRAL] I, I don't know about, oh, yes, for a regular physician's office visit, it's fixed visits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh, it's 5 visits per 6 visits.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 6 visits per calendar. OK, so, um, I don't know where we saw the 5 alright, so, um.
[CUSTOMER][NEUTRAL] So is the patient responsible for the balance then or um we don't need to adjust?
[AGENT][NEUTRAL] Well, so, so.
[AGENT][NEUTRAL] Yeah, this is a hospital indemnity plan so it's like a supplemental policy so we don't determine patient responsibility we just pay out what the benefit is for whatever service rendered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, um, can I get a call reference number please?
[AGENT][NEUTRAL] Um, call reference number is just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thanks [PII] I appreciate it.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too, thank you, bye.