AccountId: 011433970860
ContactId: 65b929cf-67b5-447e-bb78-eeadfa2cb54c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301230 ms
Total Talk Time (AGENT): 94073 ms
Total Talk Time (CUSTOMER): 44822 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/65b929cf-67b5-447e-bb78-eeadfa2cb54c_20250130T19:15_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, you're speaking to [PII]. I'm calling you from provider's office, checking on the claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, that's going to be.
[CUSTOMER][NEUTRAL] 02441226
[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 please have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] for $270 even.
[AGENT][NEUTRAL] And is this for medical, dental?
[CUSTOMER][NEUTRAL] Uh, for medical.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the correct medical policy is actually 02.
[AGENT][NEUTRAL] 441-389.
[CUSTOMER][NEUTRAL] So do you find a claim?
[AGENT][NEUTRAL] I'm pulling it up now since I have the correct policy number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And for that claim, it does show that we did receive that claim in.
[AGENT][NEUTRAL] And the receipt of that claim is showing.
[AGENT][NEUTRAL] 122 [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is showing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 36
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 554. The claim shows that it did process and make a payment of $75. Once that $75 was paid, that was the maximum amount for that date of service that could be paid out.
[CUSTOMER][NEUTRAL] OK. And how about the code 36415?
[AGENT][NEGATIVE] 36415 that claim that that date of service it shows it denied.
[AGENT][NEUTRAL] After that, 75 was met.
[CUSTOMER][NEUTRAL] OK, can I know the reason of this call?
[AGENT][NEUTRAL] As I previously stated, the maximum benefit for that date of service had been met.
[CUSTOMER][NEUTRAL] Maximum benefit, yeah, in terms of dollar amount?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what was the annual uh amount of this patient?
[AGENT][NEUTRAL] As I stated, the $75 is the maximum amount.
[CUSTOMER][POSITIVE] OK, I got it. Thank you.
[AGENT][NEUTRAL] You're welcome. And is there any
[CUSTOMER][NEUTRAL] Yeah, I'm done with this patient. Can I get the call number?
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] Alrighty thank you so much for assistance.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.