AccountId: 011433970860
ContactId: d5f4b065-294f-49f4-aa66-a501502942e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387609 ms
Total Talk Time (AGENT): 105865 ms
Total Talk Time (CUSTOMER): 127173 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/d5f4b065-294f-49f4-aa66-a501502942e6_20250310T20:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office looking for claim status.
[AGENT][NEUTRAL] I didn't understand your name. Could you spell it for me?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] [PII], OK. And you said that you're checking for a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 02567762.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] according to our records, we need a current prepayment plan.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] And we can disconnect official name is
[AGENT][NEUTRAL] And if you can verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the date of birth?
[CUSTOMER][NEUTRAL] And date of birth is April.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and so we're checking claim status for what date of service?
[CUSTOMER][NEUTRAL] Uh, date of service of this claim is [PII].
[AGENT][NEUTRAL] [PII] and what's the total charge?
[CUSTOMER][NEUTRAL] $1,522.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And have you received the explanation of benefits from American Public Life?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So I show the claim was received [PII].
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing the claim was received [PII], processed [PII].
[AGENT][NEUTRAL] Uh, no payment was made on this claim.
[AGENT][NEUTRAL] Uh, the remark code on the claim.
[AGENT][NEUTRAL] Uh, sites that the benefit maximum for this state of service has been met.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] So no benefits available for this state of service.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Oh, could you please repeat again mark code?
[AGENT][NEGATIVE] The maximum benefit is exhausted.
[CUSTOMER][NEUTRAL] The I.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Maximum benefit exhausted, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] me the
[AGENT][NEUTRAL] And are you ready for the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][POSITIVE] I like uh.
[AGENT][NEUTRAL] 331 9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. And anything else I can help out with today?
[CUSTOMER][NEUTRAL] Oh wait, please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Wait please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Anything else I can help out with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] Uh, what is the dollar amount, um, exhaust?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the date range and dollar amount?
[AGENT][NEUTRAL] The policy
[AGENT][NEUTRAL] The policy covers $50 per ER visit and the maximum number of visits are 2, and both of those visits have already been used.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] Could you please repeat again? Policy.
[AGENT][NEUTRAL] There are 2 emergency room visits per calendar year.
[AGENT][NEUTRAL] And both of the um the visits have been used for this year.
[AGENT][NEUTRAL] So there's no more benefits available.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] No, thank you. And your name, please?
[AGENT][NEUTRAL] You'll use my name and today's date as reference for today's call [PII], first initial and last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What's the movie together right.
[CUSTOMER][NEUTRAL] Yeah well that's.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][POSITIVE] OK, thank you, thank you for this service. Have a nice day.
[AGENT][POSITIVE] You're welcome, thanks for calling ATL. Have a good day as well.