AccountId: 011433970860
ContactId: d69483b1-d870-4396-b779-0a315294b0ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288019 ms
Total Talk Time (AGENT): 96448 ms
Total Talk Time (CUSTOMER): 180945 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/d69483b1-d870-4396-b779-0a315294b0ed_20250114T15:15_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Puppy Guys. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] here and I'm calling from the provider's office and I'm looking for the claim status.
[AGENT][NEUTRAL] Could you spell your name for me please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you and may I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, our callback number is [PII] and the member ID is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total charge amount was $1006 even.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For the date of service, it does show that we received that claim in on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Hmm.
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 2676. The claim shows that it processed and it denied that the per calendar day max had been met. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes, actually, uh, for this one, will you please let me know how much was the uh dollar value has met?
[AGENT][NEUTRAL] OK, so you're needing the calendar day benefits. I'm pulling it up for you as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. For outpatient, the member has up to $200 per calendar day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, for calendar days. OK. So for this one, actually, I have checked the other account also, but uh I'm not able to pull the other account for the um calendar day for this uh member.
[AGENT][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] So, uh, we have checked the, like I have checked the member's other account also for the same date of service, but, uh, I'm not able to get the other account. So how the patient has met the all the $200.
[AGENT][NEUTRAL] If the member has another claim that has came in.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And something was paid out for that date, that member has already met their benefit [PII] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, so are you, yes, so are you able to provide me that other claims details?
[AGENT][NEUTRAL] No, I cannot. It's not one of your claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claims, OK.
[CUSTOMER][NEUTRAL] OK, got it. And uh yes, for this one, could you please provide me the call reference number?
[AGENT][NEUTRAL] The call reference will be my first name [PII], last initial of H and today's date.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So, uh, it is T as in Tango, E as in Echo, R as in Romeo, I as in Indiana, C as [PII], A [PII], right?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] [PII], got it. Thank you so much, [PII], for helping me out with this one. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you.