AccountId: 011433970860
ContactId: 90a9d597-d65b-49d0-a720-fb6398384a2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382070 ms
Total Talk Time (AGENT): 119655 ms
Total Talk Time (CUSTOMER): 164073 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/90a9d597-d65b-49d0-a720-fb6398384a2e_20250519T18:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] And yes, I'm not sure that I've chose the right line. I'm calling from provider's office, and I have a claim that's showing on ER services for one of our patients, and I was just wondering. They denied the claim for non-covered, and I think it's because they must have preventative services only, so I wasn't sure which line that was.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, OK, let me check and see. It really depends on the policy and what product they have, um, but, um, let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, my name is [PII] and my number is [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], um, do you have the policy number for the member?
[CUSTOMER][NEUTRAL] Yes, I have D as in Delta 476-885-67.
[AGENT][NEUTRAL] Do you see any other numbers besides that one?
[CUSTOMER][NEUTRAL] Uh, no, I do not, other than a group number, that's it.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, are the charges, um, preventative all together, or is there like sickness and illness?
[CUSTOMER][NEUTRAL] No, it was an ER claim, and I think it's the the MEC coverage.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Minimum essential.
[AGENT][NEUTRAL] OK, I can check and see if they have a policy with us for the ER um.
[AGENT][NEUTRAL] Uh, let me have the spelling of the last name of the member.
[CUSTOMER][NEUTRAL] It's short, [PII]
[CUSTOMER][NEUTRAL] Well, and I think the cards showing [PII], so you must have it under [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now that I remember that, there was another card, but I'm, I'm not even sure if it's an old card. Oh gosh.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the first name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And you said on the card is [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the address for Mr. [PII] or [PII]?
[CUSTOMER][NEUTRAL] We have [PII].
[CUSTOMER][NEUTRAL] And that's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't have a [PII] in [PII]. Um, do you have a social by any chance, [PII]?
[CUSTOMER][NEUTRAL] Uh yes, I have [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, let's see.
[AGENT][NEUTRAL] It's not in our system. So more than likely that means that they only have IMA.
[AGENT][NEUTRAL] And IMA is for preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which you use that D number. Mhm.
[CUSTOMER][NEUTRAL] Oh, is that it?
[CUSTOMER][NEUTRAL] OK, I didn't know when it says it on the recording I'm like, hm, I don't, nothing says any because it's um it's got the MEC, you know, for minimum care.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, mhm.
[CUSTOMER][NEUTRAL] And then it has the it says preventative services only, so I didn't hear any of that verbage and I'm like I don't know what all that other stuff means, so I didn't even know which response, you know, do I do one or do I do 2.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It's OK, no problem. Do you need me to transfer you over to IMA? It's gonna be option number one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me go ahead.
[CUSTOMER][NEUTRAL] Oh, OK, well, I chose that first and then I hung up and then I called back and chose too. Sorry, so you got stuck with me.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] It's OK, no problem. Is there anything else I can help you with today before I transfer you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Oh well
[CUSTOMER][POSITIVE] No, but you have a wonderful day.
[AGENT][NEUTRAL] USL and thank you for calling APL. One moment while I transfer you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator. If you would like to participate in a quick survey after the call to rate your service with us, please press 1. Press 2 if no.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] All agents are currently assisting other callers. Please remain on the line and your call will be answered by the next agent. We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience.
[CUSTOMER][POSITIVE] Please remain on the line and we will be with you shortly.