AccountId: 011433970860
ContactId: 48f32257-e8d7-4f66-af97-96ae410ac7d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480309 ms
Total Talk Time (AGENT): 145507 ms
Total Talk Time (CUSTOMER): 175357 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/48f32257-e8d7-4f66-af97-96ae410ac7d3_20250318T14:47_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] Hello ma'am. [PII], this is [PII]. My last initial is [PII]. I'm calling from provider office and looking out.
[CUSTOMER][NEUTRAL] me.
[AGENT][POSITIVE] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you now.
[CUSTOMER][NEUTRAL] Yeah, this is [PII]. My last initial is [PII]. I'm calling from provider office. I'm looking out for the claim status. Could you please help me out?
[AGENT][NEUTRAL] I, I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure. Just a moment.
[CUSTOMER][NEUTRAL] Uh, the policy number would be
[CUSTOMER][NEUTRAL] 1116824
[AGENT][NEUTRAL] May I have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the extension would be [PII].
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient's first name is [PII], or last name would be [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have the date of service?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and the bill charges are $2000.
[AGENT][NEUTRAL] Thank you for verifying that information for future reference, you may visit our website at [PII] to check claim status as well. One moment and I'll pull this up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] This process under claim number 3557731 looks like a benefit amount of $25.76 paid to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim processed to the provider on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] 355-7731
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there any denial on the claim?
[AGENT][NEUTRAL] It looks like the outpatient benefit max was met. Looks like the
[AGENT][NEUTRAL] Charge was 3523. The benefit allowed 2576. It maxed out the outpatient benefit.
[CUSTOMER][NEUTRAL] Sorry, how much the benefit allowed?
[AGENT][NEUTRAL] This benefit allowed $2000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Calendar.
[CUSTOMER][NEUTRAL] So, patient benefit max my charges 35.23, right? The the benefit allowed per year per calendar year is $2000.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Any remaining balance becomes patient's responsibility.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So any remaining balance will be patient responsibility?
[AGENT][POSITIVE] Patience's response. Correct.
[CUSTOMER][NEUTRAL] OK. Can we bill it to the patient?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much for that information. Hm. So, can I get the call reference number?
[AGENT][NEUTRAL] It would be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you for providing such information.
[CUSTOMER][NEUTRAL] Uh, which I needed to know for today.
[AGENT][POSITIVE] You're so welcome.
[AGENT][POSITIVE] You're so welcome. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Have a great
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Uh, no, just a moment. Uh, I do have one more claim. Could you please help me out with that?
[AGENT][NEUTRAL] Is it for the same person?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So the next member would be, yeah, I'm just checking out.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] That is not a policy number?
[CUSTOMER][NEUTRAL] Mm, can I provide you the member name and the date of birth so that you can pull out the information?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the first name is [PII]. It's [PII] and last name would be [PII]. It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Can you spell the last name, please, [PII]?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I mean
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would he be the policy holder or subscriber?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't see anything here.
[AGENT][NEUTRAL] This name is not coming up. That's [PII]
[CUSTOMER][NEUTRAL] Yeah, it's the last one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have the Social Security number?
[CUSTOMER][NEUTRAL] Yeah, let me check.
[CUSTOMER][NEUTRAL] Uh, it's going to be?
[AGENT][NEUTRAL] Or the group number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm just checking this one. I don't have social security number. I do have the full contact number of the patient. Is that OK for you or you need the group number?
[AGENT][NEUTRAL] Do you have a group number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And you do not have the
[AGENT][NEUTRAL] Inpatient or outpatient certificate number.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Because I'm not pulling this person up in our system.
[CUSTOMER][NEUTRAL] OK, no problem. Um, that's a different plan, I guess.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, no, I'm just looking for this for today. Thank you so much. Thank you for providing such information which I needed to know for today. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] [PII], thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.