AccountId: 011433970860
ContactId: d67ff81e-b0e5-4c56-92cd-70edc4a9a48f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376609 ms
Total Talk Time (AGENT): 96452 ms
Total Talk Time (CUSTOMER): 95429 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d67ff81e-b0e5-4c56-92cd-70edc4a9a48f_20250205T18:15_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, this is [PII] calling from products office unit name is [PII] here.
[AGENT][NEUTRAL] OK, may I have a callback number?
[CUSTOMER][NEUTRAL] Sure. The callback number is gonna be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, that's gonna be 02455542.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is gonna be [PII]'s. Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling in for status of a claim?
[CUSTOMER][NEUTRAL] Actually, our claim has been denied here. I'm just looking on that status before moving to the claim. Can you spell out your name for me?
[AGENT][NEUTRAL] It is spelled [PII]
[AGENT][NEUTRAL] Last initial of [PII] and today's date will be the call reference.
[CUSTOMER][POSITIVE] Thank you so much for that. And can I order the claim?
[AGENT][NEUTRAL] Yes, you're needing status for that claim.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] So may I please have the date of service and the total bill?
[CUSTOMER][NEUTRAL] I'm looking on the service date of [PII] for the total charges of $234 even.
[CUSTOMER][NEUTRAL] Because that
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is for data service of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Sure, what I'm there.
[CUSTOMER][NEUTRAL] So the computers.
[AGENT][NEUTRAL] It shows that we did receive that claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim number is 3,555,350. It shows that the claim process and denied that the per calendar year max had been met on that claim.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Maxim met.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So what is the allowed unit or allowed amount on this claim?
[AGENT][NEUTRAL] We're not a major medical, so it's not an allowed amount.
[CUSTOMER][NEUTRAL] Then how to determine it has been met or not?
[AGENT][NEUTRAL] They have a benefit max, but they don't have an allowed amount. We're not a major medical.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What is the resolution for this one here?
[AGENT][NEUTRAL] So for this member, it looks like that they, for the maximum verification of coverage does not guarantee the payment of the claim. They have $11,000 per calendar year. So once we receive this claim, the maximum benefit was already met.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] When was that met?
[AGENT][NEUTRAL] I can't disclose information about another claim. I can just tell you about this one.
[CUSTOMER][NEUTRAL] You're telling that all the all the $1000 has hasn't met.
[AGENT][NEUTRAL] That's what I stated.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So can we build the balance to the patient.
[AGENT][NEUTRAL] That is to providers discretion.
[CUSTOMER][POSITIVE] Thanks for that. Just give me one moment here, [PII].
[CUSTOMER][NEUTRAL] So we are talking about the calendar year [PII], right?
[AGENT][NEUTRAL] This claim is for [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Just give me one moment here.
[CUSTOMER][NEUTRAL] Thanks for that information. And I do have a reference number with your name and date of service. Sorry, today's date.
[CUSTOMER][NEUTRAL] I think that's all day here there.
[AGENT][POSITIVE] Well, I do wanna thank you so much for calling American Public Life, [PII], you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] You as well. Bye for now.
[AGENT][POSITIVE] Thank you.