AccountId: 011433970860
ContactId: e954dd55-1045-466b-bd02-84bd2316d266
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362859 ms
Total Talk Time (AGENT): 160581 ms
Total Talk Time (CUSTOMER): 180666 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e954dd55-1045-466b-bd02-84bd2316d266_20250610T15:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Hi, I just really have a, a complaint. Do you wanna hear it?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][MIXED] I'm a little upset, but it's OK.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Um, it's on claim number 3603432.
[AGENT][NEUTRAL] 132. OK, let me pull that information really quick so I can see what we're talking about. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And just in case we get disconnected, may I have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm a nice complainer, but I am a little upset about this.
[AGENT][NEUTRAL] Mhm. I understand.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. Let me pull your EOB.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] the policy.
[AGENT][POSITIVE] And I'm so sorry. I'm just waiting on the system.
[CUSTOMER][NEUTRAL] I, I, I understand that.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] I have to work on a computer too.
[AGENT][NEUTRAL] Mhm, yeah. OK, so, um, I just need to verify some information uh for security. Let me have your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], that's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Or it's [PII], this is probably the one you want. [PII]. That's work.
[AGENT][POSITIVE] OK, we got your personal. thank you.
[AGENT][NEUTRAL] All right. um OK. So this claim was denied because the services rendered in office and it's not covered when performing in office and how may I help you with this? Uh-huh. OK.
[CUSTOMER][NEUTRAL] Yeah, I get that.
[CUSTOMER][NEGATIVE] Because I think that's sad because if my doctor is in-network and they send me somewhere, I honestly figured
[CUSTOMER][NEGATIVE] They knew where to send me. They already had it covered. They already did this. I think that's a pretty sad excuse not to cover something. I never go get this crap. So I did not know. I had to do all the research and make sure that where my doctor who is associated with you all.
[CUSTOMER][NEGATIVE] Sent me to get this test done, that you all would not pay it. But otherwise, you would have paid it.
[CUSTOMER][NEGATIVE] So now I know lesson learned, but it's just another way for the insurance people to get out of paying stuff. And I think that's really sad. That was a lame excuse. And I would be embarrassed to tell somebody this stuff. Think of something else, if you're gonna, I mean, give me a really good reason, not something like this, cause I just, just, it just makes me mad.
[CUSTOMER][NEUTRAL] I already have the bill made out, don't care, but I wanted to do a formal complaint. Makes me feel better.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK. All right procedure.
[CUSTOMER][POSITIVE] So, I mean, and I know it's not your fault, but you answered the phone so you're the lucky person to make me feel better today.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I understand. I get this.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] So, anyway.
[CUSTOMER][NEGATIVE] I was just upset that that was the reason you all didn't pay it. But now I know if I have anything done anywhere, I have to call and make sure and then tell my doctor, it's a lot of lab work. When you don't feel good and you got something going on, you shouldn't have to do all this crap. But
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][MIXED] I'm done now, so I appreciate you listening to me. Make a note that I did not appreciate this. But it's done and over.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure, I will go ahead and make a note.
[AGENT][NEUTRAL] Yes. And just for future, uh, um, we just don't pay anything in office, but you can let them know that if you go to any outpatient facility, not office or clinic, it has to be an outpatient facility that it may be considered under this policy, so it cannot be a clinic.
[AGENT][NEUTRAL] For future.
[CUSTOMER][NEUTRAL] Outpatient. So is that like an ER, I mean an urgent care or uh um what do you call them after, after hours?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Yeah, it will be like if
[CUSTOMER][NEUTRAL] Just an outpatient clinic.
[AGENT][NEUTRAL] Let me go ahead and get, bear with me just a second. I think this was, let me see what procedure was this so I can tell you exactly where where it needs to be. Um, let me go ahead and.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, hopefully I'll never have to do another one, but.
[AGENT][NEUTRAL] Yes, yes, it's best to know. OK, so this was a 69,210, so that's.
[CUSTOMER][POSITIVE] But it's still nice to know.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so it was just a procedure in the ear. Yeah, it has to be an outpatient facility. So basically a um
[AGENT][NEUTRAL] Basically it's just gonna be a
[AGENT][POSITIVE] Outpatient facility that is at, I will say an urgent care, yeah, and urgent care will be a good place.
[CUSTOMER][NEUTRAL] Like an urgent care?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's part of your benefits. The urgent care is part of your benefits.
[CUSTOMER][NEUTRAL] Ah, that's
[CUSTOMER][POSITIVE] All right. That's what I needed to know. Thank you. I appreciate you listening to me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] No, yeah, you're welcome. No problem. Is there anything else I can help you today? You too, Miss [PII].
[CUSTOMER][POSITIVE] All right, have a good day.
[CUSTOMER][POSITIVE] No, I'm done. I feel better now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, well you have a good day.
[CUSTOMER][NEUTRAL] I'm gonna go on my payment. All right. Bye.
[AGENT][NEUTRAL] OK. Bye-bye.