AccountId: 011433970860
ContactId: d54b4886-dd70-4c89-a94a-b345d083cadc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648190 ms
Total Talk Time (AGENT): 169899 ms
Total Talk Time (CUSTOMER): 103439 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/d54b4886-dd70-4c89-a94a-b345d083cadc_20250605T15:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling regarding um
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you now.
[CUSTOMER][NEUTRAL] OK, um, yes, I'm.
[AGENT][NEUTRAL] It's kind of, it's going in and out.
[CUSTOMER][NEUTRAL] OK, I, I'm calling regarding um.
[CUSTOMER][NEUTRAL] Um, a bill that I got from, uh, an MRI and I have the, the centers, the billing in on the line as well. Um, I sent you guys the explanation of benefits that you needed to see, um, in order to process that claim and, um, according in their records they still doesn't show any updates so.
[CUSTOMER][NEGATIVE] I'd like to to get to the bottom of this. I'm supposed to get another MRI done. Um, it's already past due and I haven't been able to do it because this bill is, is open and unpaid and this is becoming very urgent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely look into it for you and see what's going on with the claim. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, can I give you the social or, I mean, hold on.
[AGENT][NEUTRAL] Sure, that's fine.
[AGENT][NEUTRAL] Uh oh, it went out again. Hello.
[CUSTOMER][NEUTRAL] I, I got policy.
[CUSTOMER][NEUTRAL] Yeah, hello, policy is.
[CUSTOMER][NEUTRAL] 018
[CUSTOMER][NEUTRAL] 325
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, so I have the policy here. I just need you to verify your date of birth, mailing, and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The [PII]. [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And is this for, looks like [PII] for [PII]?
[CUSTOMER][NEUTRAL] Or an [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like this is the diagnostic and this is the last claim. Hold on one moment.
[AGENT][NEUTRAL] All right. And do you mind if I place you on just a brief hold while I take a look at the claim and the documents?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and if, cause the phone's going in and out, if it does hang up or anything, I'll give you a call back so we can continue, OK? I'm not gonna just leave you hanging, OK?
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for the wait. Um, I was just looking at the documents that were received, um, the denial reason and the benefits that you have on the policy. Um, I'm gonna go ahead and send this over to claims. I'm going to make it urgent, um, so that they can give you a call back, hopefully today if not tomorrow the latest um because it's going to be marked urgent.
[AGENT][NEUTRAL] But I'm gonna have a claims examiner give you a call to give you more information about the claim and how it was processed and if it was processed incorrectly, we can get it reprocessed for you because I
[AGENT][NEUTRAL] I'm not showing where.
[AGENT][NEUTRAL] So it was denied because the policy only covers what's listed in the schedule of benefits, but it's an MRI.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And that's covered. So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it's been covered in the past. I mean, I've, I've gotten it covered in the past.
[AGENT][NEUTRAL] Yes, I don't, I don't want to say the wrong thing because I'm not an examiner, but I don't, I'm gonna have them look at it and give you a call to give you an update, um, because I don't, I I see that MRIs are covered, so I don't, I don't understand.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and is the [PII], is that the best contact number for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm sending it over to them now and I have marked it urgent, so it's 24 to 48 hours tomorrow at the latest, um.
[AGENT][NEUTRAL] And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That's it, so you said by tomorrow they should be giving me a call?
[AGENT][NEUTRAL] Yes, I'm hoping for today, um, but tomorrow is the the max that it could have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, I'll wait to hear back then. Thank you.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL and I hope you have a good day.
[CUSTOMER][NEUTRAL] Um, is there, um, like a reference number in case they don't call me and I need to call back or?
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name in today's date, and I'm [PII]. I'm the only [PII] here, um, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.