AccountId: 011433970860
ContactId: d71fe5ce-5b5d-4002-a758-ca323def7944
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409220 ms
Total Talk Time (AGENT): 151247 ms
Total Talk Time (CUSTOMER): 160262 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/d71fe5ce-5b5d-4002-a758-ca323def7944_20250429T13:46_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I've got your uh insurance through my job, uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Since last July.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I have regular, uh, Blue Cross insurance, and your insurance pays the copay every time I go to the doctor, they pay the copay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, this doctor that I'm at right now just called you guys and somebody told him that you don't pay the copay.
[CUSTOMER][NEGATIVE] So he's not accepting this to pay the copay, but I know for a fact that's the whole reason that we have this, and this is what you guys do. I've been on the phone with you guys 5 times in the last year, and every time it's the same story you guys do pay the copay. So somebody just gave this guy the wrong information and now he's trying to charge me my copay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm so sorry for that. Uh, I can go ahead and check on it and also speak to the provider if I need to, OK? Um, may I have um your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes please it's [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The outpatient benefit number?
[AGENT][POSITIVE] Yes, mhm. Yes.
[CUSTOMER][NEUTRAL] Is that what you're looking for?
[CUSTOMER][NEUTRAL] 0250
[CUSTOMER][NEUTRAL] 7709.
[CUSTOMER][NEUTRAL] M like Mary. L like Llama 8.
[AGENT][NEUTRAL] All right. And may I have um your date of birth, mailing address and email address for security.
[CUSTOMER][NEUTRAL] Yeah, [PII], uh [PII].
[CUSTOMER][NEUTRAL] And what else did you ask for?
[AGENT][NEUTRAL] The email address?
[CUSTOMER][NEUTRAL] Oh, it's my full name [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm looking into your benefits. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is the reason my company gives us this insurance for free is just to pay copays literally why the whole company uses it.
[CUSTOMER][NEUTRAL] I don't even know what else you guys do to be honest, besides that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, you have many more benefits than just the office, but yeah.
[CUSTOMER][NEUTRAL] Oh, don't know what else to.
[CUSTOMER][NEUTRAL] I'm sure.
[CUSTOMER][NEUTRAL] I'm sure I have no idea what any of them are, yeah.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so I do see that we cover um,
[AGENT][NEUTRAL] This is Mty now, this is, uh, OK, so this was an urgent care.
[AGENT][NEUTRAL] Bear with me just a second trying to determine.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] This is also an urgent care.
[AGENT][NEUTRAL] The one that you're visiting right now, is it an urgent care or is it a regular office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's both.
[CUSTOMER][NEUTRAL] Yeah. It's both, it's my regular doctor's office, but it's also an urgent care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. What's the doctor's name?
[CUSTOMER][NEUTRAL] Doctor [PII].
[CUSTOMER][NEUTRAL] S A B like boy I D O D like dog.
[AGENT][NEUTRAL] Give me just one more minute.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK, that's.
[CUSTOMER][NEUTRAL] There's an urgent care I went to in [PII] that took the
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Insurance with no problem twice I've been over there, but then there was another one I went to in [PII] that gave me a really hard time.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Mhm. Yeah, the urgent cares are definitely covered. That's something that it is covered. So that's why I'm trying to see if we have paid an office visit before. Um, I don't see that benefit on the policy. Um, I see that you have benefits for procedures done in the office but not for the co-payment of the office.
[AGENT][NEUTRAL] Um, again, we cover urgent care, co-payment or ER co-payment, um, or diagnostic centers, but I don't see a regular office.
[CUSTOMER][NEUTRAL] So you, so you do cover.
[CUSTOMER][NEUTRAL] Yeah, but you cover everything you cover office visits you guys cover.
[CUSTOMER][NEUTRAL] Supposed to be every single copay.
[CUSTOMER][NEUTRAL] We don't pay copays at all.
[AGENT][NEGATIVE] Not the office visit. It's, it's the only thing we do not cover is the regular office visit co-payment. That one is not covered.
[CUSTOMER][NEUTRAL] OK, but, but being an urgent care, you do cover it.
[AGENT][NEUTRAL] Urgent care, we do cover, yes.
[CUSTOMER][NEUTRAL] OK, well, it literally is in the name of the doctor's office. Total MB Family Medicine and urgent care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yeah, if it's an urgent care, if they charge us an urgent care, then we do cover. Um, I can go ahead and let them know that that is part of your coverage if they charge us an urgent care. It's just an office. If it's regular office, uh, like specialist or PCP regular doctor, no, it will not cover. But if it's an urgent care, it will.
[CUSTOMER][NEUTRAL] I'm looking right at it.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I don't think that that's correct and I need to, I need to know why that is because I'm gonna call my, my HR lady. There shouldn't be any co-pays that are not covered by this.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You can, yeah, you can check on it because yeah, it's been since [PII]. I do see the benefits here. I'm looking at the breakdown of the benefits, but yeah, it's always been like that since the [PII].
[CUSTOMER][NEUTRAL] I don't know what the confusion on that is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you need me to give this information to the provider or?
[CUSTOMER][NEUTRAL] Yeah, you can tell them she's saying if it, if it was an urgent care that they cover it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you for your time.
[AGENT][NEUTRAL] You're welcome. Is there