AccountId: 011433970860
ContactId: 6b4a6e7b-88af-44b0-9bc4-2c58da7667e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245830 ms
Total Talk Time (AGENT): 103282 ms
Total Talk Time (CUSTOMER): 88342 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/2025/06/24/6b4a6e7b-88af-44b0-9bc4-2c58da7667e2_20250624T14:44_UTC.wav
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[AGENT][NEUTRAL] assist you.
[AGENT][NEUTRAL] Thanks for calling AP. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from provider's office Ri claim status.
[AGENT][POSITIVE] Sure, [PII], I can assist you with that.
[AGENT][NEUTRAL] Can I have a callback number for you and that policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] Could you slow down with that callback number and give it to me again? I have to type it into the system.
[CUSTOMER][NEUTRAL] And the extension is [PII].
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] And the extension is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That policy ID number is
[CUSTOMER][NEUTRAL] 02611291.
[AGENT][NEUTRAL] What is this member's name that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] And most need
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And you're calling to check the status of a claim. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the data service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Do you have a procedure code?
[CUSTOMER][NEUTRAL] And that
[AGENT][NEUTRAL] Or is it an ER visit?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, the procedure code we have.
[AGENT][NEUTRAL] Do you have a total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the total bill amount is $2,174.95.
[AGENT][NEUTRAL] Thank you. So it looks like we only made a payment of $50 on this claim.
[CUSTOMER][NEUTRAL] OK, so what about the remaining balance? The total allowed on pay is 50?
[AGENT][NEUTRAL] So this is not a primary insurance company so I can't, I'm not allowed to tell you that it's the patient's responsibility. However, I can only verify that we only made a payment of $50 which was the maximum benefit amount allowed for the data service.
[CUSTOMER][NEUTRAL] OK, so what about the remaining balance? Is there any denial on this claim?
[AGENT][NEUTRAL] No, there was no denial, just verify that we only pay the amount, the member's benefit amount per visit is $50 per visit with 4 visits per calendar year, and this is not a guaranteed benefit it's just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] So the remaining balance is the patient responsibility.
[AGENT][NEUTRAL] I can't tell you that [PII], because we're not a primary insurance company. I can only verify that we made a payment of $50 on the claim that you submitted here to American Public Life.
[CUSTOMER][NEUTRAL] So, OK, actually,
[CUSTOMER][NEUTRAL] So you are the second insurance to this number, right? The primary and uh other coverage.
[AGENT][NEUTRAL] I'm not sure we're not affiliated with any other insurance company, but I can only verify that we made a payment of $50. There's the full, the maximum benefit amount allowed here at American Public Life for the member's policy.
[CUSTOMER][NEUTRAL] OK, so as for the member's policy, this is allowed unpaid amount, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Could you please spell out your name for documentation purpose?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] In today's date of the reference.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The reference number is your name and today's date, right?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Thank you so much and thank you so much.
[CUSTOMER][POSITIVE] Uh, no, I got all the information. Thank you so much for your assistance.
[AGENT][POSITIVE] Thanks for calling APL and have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Bye.