AccountId: 011433970860
ContactId: 02330f1b-b2bf-417b-8801-ebc5b50f9cc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292380 ms
Total Talk Time (AGENT): 130509 ms
Total Talk Time (CUSTOMER): 86791 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/02330f1b-b2bf-417b-8801-ebc5b50f9cc1_20250204T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm looking for status of a claim.
[AGENT][NEUTRAL] I can verify claim status. May I have your name and the policy number?
[CUSTOMER][NEUTRAL] My name is [PII]. The policy number is D for Delta 41203269.
[AGENT][NEUTRAL] I do apologize, that is not our policy number. Do you have the social security number or I can do a name search?
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Uh, no, I don't have the social. The patient is [PII], yeah, first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] Can you spell that, please?
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] The data service for the patient is [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] $740 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well.
[AGENT][NEUTRAL] The policy number will be?
[CUSTOMER][NEUTRAL] Uh, do you need a lot for your?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I apologize, you need a log in for your website?
[AGENT][NEUTRAL] Yes, you would create it under the provider.
[AGENT][NEUTRAL] Portal.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, what was the portal again? I apologize.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. I apologize. ID number.
[AGENT][POSITIVE] You're welcome. No worries.
[AGENT][NEUTRAL] The ID number is 0242.
[AGENT][NEUTRAL] 7332.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. This process under claim number 349-6732 looks like no benefits were payable.
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] The claim submission received has been noted as an accident or injury. The outpatient sickness writer allows payment for sickness only, so it was not covered under this policy.
[CUSTOMER][NEUTRAL] So you guys have this patient as a no-faul patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You're, you're saying that this is benefits um that should be built to no fault?
[AGENT][NEUTRAL] Under this plan, um, this is a hospital indemnity plan, so it is a limited benefit plan. So it looks like.
[AGENT][NEUTRAL] This plan only covers
[AGENT][NEUTRAL] Illness
[AGENT][MIXED] Yes, this plan only covers sickness.
[CUSTOMER][NEUTRAL] And when you say sickness, you mean like cancer, um, transplant cases, that type of stuff?
[AGENT][NEUTRAL] Or stomach ache, backache, anything like that. So this looks like this was an accident.
[AGENT][NEUTRAL] So sickness or illness only is covered under this plan.
[CUSTOMER][NEUTRAL] Um, have you guys sent any accident questionnaires to the patient by any chance?
[AGENT][NEUTRAL] Yes, this, um, once this claim was processed, it processed on.
[AGENT][NEUTRAL] 823, a copy went to the insured and a copy went to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the reference number for this call, please?
[AGENT][NEUTRAL] It will be my name which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life Virginia. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Likewise, thank you, bye.