AccountId: 011433970860
ContactId: becaa970-9edd-4890-9929-198c4c5fe15d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 679799 ms
Total Talk Time (AGENT): 233414 ms
Total Talk Time (CUSTOMER): 228616 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/becaa970-9edd-4890-9929-198c4c5fe15d_20250415T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, how is it [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. Nice to meet you, [PII]. Uh, my name is [PII]. Um, I was looking through
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] I was looking through one of the claims um that I had and.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, so I, I went for a regular checkup with the doctor, and it, it was supposed to be covered by my MEC plan.
[CUSTOMER][NEUTRAL] Right? Um, but the problem was, uh,
[CUSTOMER][NEUTRAL] I got the service when I still had the MEC plan.
[CUSTOMER][NEUTRAL] And then the claim was was processed.
[CUSTOMER][NEUTRAL] Are they received the claim in April.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not sure and then I got I got like um uh a random bill.
[CUSTOMER][NEGATIVE] For this, and it should have been covered by MEC plan when, when I, when I was under the MEC plan, cause I got a day, the day of service was during when I had the MEC.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK. All right, [PII]. Uh, I can look at your claim for you. Can you please give me your callback number, sir, just in case the call gets dropped, I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Right, this is, this is a callback number, um.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Uh, my policy number, I have to look at that again. Policy number? Well, so I'm not sure about old policy number, um, because, give me a second, let me look that up.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes sir, if you have an old one, it'll pull in all of your policies for me.
[AGENT][NEUTRAL] Even if it's a new one or an old one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, the ME, so MEC plan is a different number.
[CUSTOMER][NEUTRAL] So the MEC has uh employee ID and the group number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It doesn't have a policy number on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the group?
[CUSTOMER][NEUTRAL] Uh, but my personal policy.
[AGENT][NEUTRAL] Yes, sir, go ahead.
[CUSTOMER][NEUTRAL] The group number is 9490.
[AGENT][NEUTRAL] OK, and then what is the policy number that you're showing?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The policy number for the
[CUSTOMER][NEUTRAL] The hospital amenity is 259-723, but it seems like the MEC doesn't have a policy number.
[AGENT][NEUTRAL] OK, let me look 259-723.
[CUSTOMER][NEUTRAL] Right, that's the group hospital amenity, but that's different than the MDC.
[AGENT][NEUTRAL] OK, um, let's look up with your social. Can you give me that?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, let me pull you up that way. That'll pull in everything you've ever had with us.
[AGENT][NEUTRAL] OK, [PII], what is your last name, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. OK, thank you.
[AGENT][NEUTRAL] And then can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then I'll also need for you to verify your address, phone number, and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So it's [PII]. The number is [PII]. The email is [PII].
[AGENT][NEUTRAL] OK, I appreciate you verifying that information. Now I do see a claim that was reported on [PII]. Is that the one that you're?
[CUSTOMER][NEUTRAL] Of course, of course.
[AGENT][NEUTRAL] In question about? OK.
[CUSTOMER][NEUTRAL] Yeah, a claim, uh, yeah, I had, yeah, it was a question regarding, cause like I, I thought that when I had the er, when I had the MEC plan, I was like, hey, they say it'll cover everything. I was like, OK. And then two months later, I get a bill and I'm like, OK, and the bill is not cheap.
[AGENT][NEUTRAL] OK, alright, so the, the claim number that I'm showing for um that the data service, let me tell you.
[CUSTOMER][NEUTRAL] It's 35874.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, the claim number is uh.
[AGENT][NEUTRAL] Let me go back to it again.
[AGENT][NEUTRAL] 3587452. Um, it was for data service of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied, and the reason why it was denied was this policy does not provide benefits for vaccines and immunizations or administration of injections.
[AGENT][NEGATIVE] is not covered under your policy.
[CUSTOMER][NEUTRAL] Right, but.
[CUSTOMER][NEGATIVE] But it, it's, but it was covered under the, what's it called, the group hospital amenity, but it should have been covered under the MEC.
[CUSTOMER][NEUTRAL] Right. Does that make sense? The MEC, it's, it's meant for preventive measures.
[AGENT][NEUTRAL] OK, so what I can do.
[CUSTOMER][NEUTRAL] Yeah, so that's, that's mhm.
[AGENT][NEUTRAL] Right, what I can do is, um, because I can only see how the claim was processed um with the remarks I can get somebody from the claims department get a claims specialist to call you back and they can go over the claim with you and you can let them know your concerns about it being under the MEC.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If that would help you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] Yeah, that, that would be great. um, I, I, I will be busy. I will be busy in the next few in the next few, uh.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Like an hour, I mean like the next actually few, few hours. Do you know when they'll get back to me by?
[AGENT][NEUTRAL] It will be within 24 hours. Um.
[CUSTOMER][NEUTRAL] OK, yeah, no, that'll be good because I, my, my.
[AGENT][NEUTRAL] But what I'm gonna do is I'm gonna.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because my, I, I'm on do not disturb during the workday, and it might be hard for them to reach me. So, um, I, I, I, cause I, I don't know if there's like a better way they could reach me because I would love to talk about this because like the bill, um, it's like a few $100 and, you know, right, especially when this state of economy, like a few $100.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's like to be so difficult, so.
[AGENT][NEUTRAL] Uh yes, I understand. OK, so when is the best time to call you back?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Anytime tomorrow. I, I'll, I'll turn off my do not disturb. I do not, I will turn off my do not disturb um off tomorrow.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So feel free for them to call me any time tomorrow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And then, and then I have like the proof on my paycheck that I was getting deductions for MEC even, because I canceled it in the end of, in the beginning of March, I was still getting deducted all the way into April. So I'm, I don't know what's going on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, alright, so I'm gonna put you on a brief hold, [PII] while I get this request sent in for somebody from the claims department to have a specialist call you back, and I will be right back with you, sir.
[CUSTOMER][POSITIVE] Thank you so much thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hi, hi [PII], this is [PII] back with you again. Um, can you please give me the phone number that you would like for them to call you back at tomorrow?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 34142.
[AGENT][POSITIVE] Thank you so much for holding for me [PII]. I've got that request sent in you should be getting and I put a note on there to call any time during the day tomorrow and I gave your phone number that you just gave to me for a claims specialist to call you back.
[CUSTOMER][POSITIVE] Got it thank you so much.
[AGENT][POSITIVE] You're very welcome. Is there anything else that I can help you with, [PII], before we go?
[CUSTOMER][POSITIVE] Um, no, that, that is all. Thank you so, so much, uh, yeah, I just wanna make progression on this case.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes sir and you like I said, you should be getting a call back.
[CUSTOMER][MIXED] Alright, but other than that, thanks.
[CUSTOMER][POSITIVE] Perfect, perfect, thank you so much uh other than that, thank you so much and I really do hope you have a good rest of your day, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Well, you too, [PII]. I hope you have a blessed rest of your week and we thank you for calling APL.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, thank you so much for helping me out. Have a good day. Bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.