AccountId: 011433970860
ContactId: cd5d26ba-8420-4849-88d8-25d4fadb6b20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450000 ms
Total Talk Time (AGENT): 131159 ms
Total Talk Time (CUSTOMER): 146176 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/cd5d26ba-8420-4849-88d8-25d4fadb6b20_20250219T20:41_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]. This is [PII] calling from the provider's office.
[CUSTOMER][NEUTRAL] Uh, I needed help with the training. Can you please help me with that?
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's going to be.
[CUSTOMER][NEUTRAL] 02556132 M as in Mary, L as in Lima, 7.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, it would be [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] It's going to be $62,295.06.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well.
[AGENT][NEUTRAL] This processed under claim number 356-483-5.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] It looks like a benefit amount of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $421 paid to the provider.
[AGENT][NEUTRAL] This claim processed on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. What was the allowed amount?
[AGENT][NEUTRAL] It looks like with this claim.
[AGENT][NEUTRAL] The allowed amount was $1,503.91. The benefit allowed for 2173 s. It looks like the inpatient max was met with this claim.
[AGENT][NEUTRAL] So this policy allows 1500 per calendar year and this claim, the benefit met with 42173.
[CUSTOMER][NEUTRAL] Uh, you said Benefit Max. I was unable to get it. Can you please elaborate?
[AGENT][NEUTRAL] The inpatient per calendar year allows 1500.
[AGENT][NEUTRAL] So when this claim was received, the balance only allowed 421 73 to match that benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, uh, give me a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, yes, uh, you said the, uh, inpatient services for [PII] are maxed out when this claim was, uh, submitted, so, uh.
[CUSTOMER][NEUTRAL] What was the date of service before like under which claim did you pay this before this claim?
[AGENT][NEGATIVE] It, it was a claim prior to this claim being received. It was not the same provider.
[CUSTOMER][NEUTRAL] And I figured that out
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] Can you tell me the provider's name?
[AGENT][NEUTRAL] No, I cannot.
[CUSTOMER][NEUTRAL] Uh, and by any chance, do tell me the same number or maybe the date of service.
[AGENT][NEUTRAL] I cannot.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] O
[CUSTOMER][NEUTRAL] Uh, so, um.
[CUSTOMER][NEUTRAL] Uh, can you at least provide me with the date of service?
[AGENT][NEUTRAL] I cannot provide you any information on another claim submitted by a different provider. I cannot.
[CUSTOMER][NEUTRAL] If possible.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, yeah, can you fax us the PDOB?
[AGENT][NEUTRAL] May I have a fax number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Uh, can you email us the fax you if possible?
[AGENT][NEUTRAL] I can fax it over to you.
[CUSTOMER][NEUTRAL] OK, no issues. Uh, the fax number is going to be [PII].
[AGENT][NEUTRAL] I will fax it to [PII]. I'll fax this right over.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're so welcome. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yes. Uh, how much time would it take for the fax to reach us?
[AGENT][NEUTRAL] I am faxing it over right now.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][POSITIVE] Thank you for calling American Public Life, Jill. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Even Medicaid for