AccountId: 011433970860
ContactId: 2d983cf3-d21a-43e4-9da9-6bfd92fac04b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586409 ms
Total Talk Time (AGENT): 161717 ms
Total Talk Time (CUSTOMER): 180106 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/2d983cf3-d21a-43e4-9da9-6bfd92fac04b_20250610T19:39_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from MESC physicians to check on the claim status.
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][POSITIVE] And that's right.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Sure callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], that right?
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, policy number is 015.
[CUSTOMER][NEUTRAL] 54898. And if you don't mind, ma'am, could you spell out your name for me for my documentation purpose?
[AGENT][NEUTRAL] It is spelled [PII] with the last initial of [PII] and today's date as the call reference.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII].
[AGENT][NEUTRAL] You're welcome, and may I please have the member's first and last name and their date of birth?
[CUSTOMER][NEUTRAL] Sure, ma'am's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For the bill amount of $1,989 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is for data service of 95 or 24 total bill charge $1,989. I did pull that claim up for you and you can also check claim status via our secured portal that is [PII].
[CUSTOMER][POSITIVE] Mm, that's right.
[AGENT][NEUTRAL] And claim we did receive it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That claims 3583972 it denied requesting primary EOB. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Mm just a moment.
[CUSTOMER][NEUTRAL] The patient's plan name and plan time.
[CUSTOMER][NEUTRAL] Actually, we do have 2 more claims for different number. Will you able to help me for the claim status too?
[AGENT][NEUTRAL] OK, so for this member, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] No, before that, can I get the reference number for this call?
[AGENT][NEUTRAL] As I previously stated, it is first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Mm. Got it. Thank you so much for the information, [PII].
[AGENT][NEUTRAL] And may I please have the next policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next policy number is 024.
[CUSTOMER][NEUTRAL] 54122.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Day of service and total bill.
[CUSTOMER][NEUTRAL] Day of service is [PII] for the bill amount of $277 even.
[AGENT][NEUTRAL] And it does show that we did receive that claim on [PII]. It was processed on [PII]. That claim number is 357.
[AGENT][NEUTRAL] 1239 that claim process and it denied that the maximum amount has been met for this member.
[CUSTOMER][NEUTRAL] Mm, got it. So the maximum amount for this number has been exceeded, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know how much download a month for this?
[CUSTOMER][NEUTRAL] Member.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Can I get the family details?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And for this policy verification of coverage does not guarantee the payment of the claim. The member did have up to $4000 per calendar year.
[CUSTOMER][NEUTRAL] It's 4, sorry, it's $4000 per calendar year, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And may I know when was the last?
[CUSTOMER][NEUTRAL] OK, it was met.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I can't disclose that information.
[CUSTOMER][POSITIVE] should be the one, yeah.
[CUSTOMER][NEUTRAL] Mm. Got it.
[CUSTOMER][NEUTRAL] Thank you and can I get a claim?
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, because I just want to know whether it is.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh, yeah, I just want, I just want to know the date when it was last met because uh after the data service or before the data service.
[AGENT][NEUTRAL] I can't disclose that information that is not your claim.
[CUSTOMER][NEUTRAL] fax number. Can I do that. Got it. Can we go to the next claim when you're ready?
[CUSTOMER][NEUTRAL] For the previous time you can provide me the same number. Can you provide to the claim for the previous one for Sunday.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Next policy number is 127.
[CUSTOMER][NEUTRAL] 5591.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth, [PII].
[AGENT][NEUTRAL] Day of service and total bill.
[CUSTOMER][NEUTRAL] Data services [PII].
[CUSTOMER][NEUTRAL] For the amount of $427 even.
[CUSTOMER][POSITIVE] Take care.
[AGENT][NEUTRAL] And that is for data services 104427. I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] So the date is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] And for that claim it does show that we received it on [PII]. It was processed on [PII]. That claim number is 358.
[AGENT][NEUTRAL] 1086 it denied that office visits are not covered and that also we're needing the primary EOB.
[CUSTOMER][NEUTRAL] So the claim for primary year, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][POSITIVE] Mm. Got it. That's all for today. Thank you so much for patiently assisting me, [PII]. Have a good rest of your day. Stay safe. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well, [PII].