AccountId: 011433970860
ContactId: 0a9cd440-ebcb-4055-9914-8f138e8599f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259730 ms
Total Talk Time (AGENT): 119612 ms
Total Talk Time (CUSTOMER): 68180 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/0a9cd440-ebcb-4055-9914-8f138e8599f5_20250206T20:31_UTC.wav
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[AGENT][POSITIVE] Hi, thank you so much for calling EPL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office regarding claim status. Could you please help me out for today?
[AGENT][POSITIVE] Yeah, I'd love to help you with the claim status today and could you spell your name for me, pretty please?
[CUSTOMER][NEUTRAL] [PII]. Last initial is my name is [PII].
[AGENT][POSITIVE] Thank you and what is a great callback number I can get from you real quick, my friend?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the policy number we want to look at today?
[CUSTOMER][NEUTRAL] 02510281.
[AGENT][NEUTRAL] 02510 and then what was the last of it? I'm so sorry.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 102
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 81
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][POSITIVE] Yes, absolutely. It's [PII], first initial, last name, [PII].
[AGENT][NEUTRAL] And would you be able to go ahead and verify for me your member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And let me get claim information pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. What's the date of service on the claim we wanna look at today?
[CUSTOMER][NEUTRAL] Uh, [PII]. And date ranges to be [PII].
[AGENT][NEUTRAL] OK perfect and then the bill amount?
[CUSTOMER][NEUTRAL] $3,196 even.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] All right. And hang tight. I believe I found it. I just need to try to pull it up real quick.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] Would you be able to verify for me pretty please the name of the facility on file?
[CUSTOMER][NEUTRAL] Yeah, Franklin Woods Community Hospital.
[AGENT][NEUTRAL] OK, perfect. I definitely did find that claim for you my friend. It looks like we received your claim on [PII]. It looks like the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number is 3549718.
[AGENT][NEUTRAL] And I do show the claim here did deny. I have the reason stating.
[AGENT][NEUTRAL] That the calendar year maximum for outpatient accident and sickness treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is the next step for me for the process the claim?
[AGENT][NEUTRAL] Um, so as far as American Public Life goes, we can only approve or deny a claim because we're supplemental. Uh, we can't determine patient responsibility and we make no advice on what next steps the provider needs to take. That will be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. What is the call reference number, miss?
[AGENT][NEUTRAL] You betcha. It's my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help. Have a great day and God bless you.
[AGENT][POSITIVE] My pleasure. You too, take care. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] That