AccountId: 011433970860
ContactId: 5cd8cba4-c6ee-4043-9ac2-ec51da840e78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229850 ms
Total Talk Time (AGENT): 83769 ms
Total Talk Time (CUSTOMER): 114730 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/5cd8cba4-c6ee-4043-9ac2-ec51da840e78_20250317T14:43_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 [PII], um, I'm sorry, I just called there probably about 5 minutes ago. Um, I just have a question in regards to a patient. You guys issued a a check to us for this patient for, um, their claim, but I have a question.
[AGENT][NEUTRAL] OK. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure, it is 1,252,290, M as in Mike, L as in Linda, and 5.
[AGENT][NEUTRAL] May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] callback number [PII].
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII] is the first name, then [PII] and then [PII]. Um, her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And what is the claim number for that check?
[CUSTOMER][NEUTRAL] It is, hold on, give me a sec.
[CUSTOMER][NEUTRAL] She gave it to me. Hold on. Um, 365. I'm sorry, 356. I have dyslexia this morning. I apologize. 356-318-2.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And it is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me get this pulled up one moment.
[AGENT][NEUTRAL] OK, looks like data service [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me get this pulled up it's under a different policy number.
[AGENT][NEUTRAL] OK. Venture ambulatory surgery and I'm ready.
[CUSTOMER][NEUTRAL] OK, so the question that I have is, um.
[CUSTOMER][NEUTRAL] Did the patient, because the way you guys paid it was $795.94 and the patient claim was for $1,179 which is the patient's um deductible amount. So do you guys pay a percentage of the patient's deductible? I'm just trying to figure out what's the difference.
[AGENT][NEUTRAL] It looks like this plan will pick up the copays the co-insurance and our deductibles, but for outpatient, they have a benefit max of $2500. So the allowed amount was $1,179 but the benefit only paid the $795. It maxed out the benefit with that $795.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So any remaining balance becomes patient's responsibility.
[CUSTOMER][NEUTRAL] OK, I got you. And how much is that a year you said? I'm sorry.
[AGENT][NEUTRAL] 2500.
[CUSTOMER][NEUTRAL] OK. So she probably has something else before then. OK, I just wanted to make sure so if the patient asks, I can be able to explain um what happened here.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, what did you say your name was again?
[AGENT][NEUTRAL] It's [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that is it. Thank you so much for your help.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.