AccountId: 011433970860
ContactId: 367585db-5f9f-4f31-87a7-47836cdfbb46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237380 ms
Total Talk Time (AGENT): 62544 ms
Total Talk Time (CUSTOMER): 100021 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/367585db-5f9f-4f31-87a7-47836cdfbb46_20250313T17:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], I'd like clarification on a claim for a patient, please.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 02476254
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] $590.
[AGENT][NEUTRAL] OK, I've pulled the claim up. How may I assist you?
[CUSTOMER][NEUTRAL] OK. Um, it says the claim paid $75. Is there any patient responsibility?
[AGENT][NEUTRAL] Once we made that payment, it, uh, we don't advise the provider of how to bill, so we only can just.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Advised of that was the maximum amount that will be paid out. So that is the provider's discretion if they submit that to the insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK. Uh, so to the insurance, I thought you were insurance.
[AGENT][NEUTRAL] Insured.
[CUSTOMER][NEUTRAL] Oh, insured. OK. I'm sorry, I heard wrong. OK, because, um, your, the, the, the, the explanation of benefit we received, it's only normally to have like a uh a uh provider write off or or something like that, but it only has like the payment so that's why I was um curious about it.
[AGENT][NEUTRAL] It should have also indicated that that was the maximum amount for that date of service.
[CUSTOMER][NEUTRAL] OK, yeah, it does say maximum for that date of service, uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, let's see. Yeah, I guess.
[CUSTOMER][NEUTRAL] OK, so you're saying is, is the provider's discretion how they want it if we, if we're gonna take the discount or not.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I want to build the patient for the remainder.
[AGENT][NEUTRAL] If, if the provider is wanting to submit that to the insured, that is his decision.
[CUSTOMER][NEUTRAL] Oh OK, all right, thank you. Could I have a reference number please?
[AGENT][NEUTRAL] Yes, the reference number would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] OK. Um, could, uh, another question. If, um, what, OK, let me formulate my thoughts. So one second. If there was a patients, do you tell patient responsibility or no? Or you just said that's the, that's what you're gonna pay and that's it?
[AGENT][NEUTRAL] That's just the amount that we will pay. This policy is a contracted or an indemnity policy, so it's a limited benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK. Got you. All [PII]. OK, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thanks, bye.