AccountId: 011433970860
ContactId: d7c520ce-f79f-47ee-870d-b0de3e13600a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270880 ms
Total Talk Time (AGENT): 96968 ms
Total Talk Time (CUSTOMER): 110851 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/d7c520ce-f79f-47ee-870d-b0de3e13600a_20250408T17:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider office. I need to verify the patient's claim status.
[AGENT][NEUTRAL] OK, can I get a callback number please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, the policy number you're calling on?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The policy number is 02332588 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] The patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy. And [PII], you say you're calling for status. What is the data service you're checking?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $362.66.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. I do show the claim was received. It looks like the claim was denied. Uh, the outpatient calendar year outpatient maximum was met prior to this um claim and so there were no benefits available.
[CUSTOMER][NEUTRAL] Just one second.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Mm, I didn't get that is the claim has been received.
[AGENT][NEUTRAL] Yes, the claim was received and denied. Outpatient max met for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But, uh, may I know the last mid date because it's showing this uh we didn't get any payment on your side.
[AGENT][NEUTRAL] We did not pay the claim, sir. The claim was denied.
[CUSTOMER][NEUTRAL] So can you verify it?
[CUSTOMER][NEUTRAL] OK, but we already spoke with the patient, so the patient stated, um, the patient responsible amount is, uh, paid by the sec uh secondary insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why I called. Is that, uh, so can you verify that one? Is that possible?
[AGENT][NEGATIVE] And as I stated, the claim was denied. There were no benefits allowed. There were no benefits available for [PII]. They had maxed out their outpatient benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, for this patient does not have any benefits for this year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, may I know your name, please?
[AGENT][NEUTRAL] My name is [PII] Would you like a copy of the explanation of benefits sent to you?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm yeah yeah.
[AGENT][POSITIVE] OK, let me get that pulled up for you.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And will I be sending that to your attention?
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][NEUTRAL] OK, and what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. I'm repeating it's [PII].
[AGENT][NEUTRAL] OK, it is on its.
[CUSTOMER][NEUTRAL] And attention to me, [PII].
[AGENT][NEUTRAL] OK, it is on its way. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm, no, that's it. Can I get the call reference number?
[AGENT][NEUTRAL] To reference the call, you'll use my name, [PII] and today's date.
[CUSTOMER][NEGATIVE] OK, and I have one more doubt for this, uh, for this data service or the whole data service does not have any benefits, right?
[AGENT][NEGATIVE] They have no more benefits available for the year of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah OK thank you.
[AGENT][POSITIVE] You're welcome you have a wonderful day. Thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] Yeah