AccountId: 011433970860
ContactId: dbd526d9-aef8-476c-8ca3-068fbfd97d4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256970 ms
Total Talk Time (AGENT): 118002 ms
Total Talk Time (CUSTOMER): 78968 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/dbd526d9-aef8-476c-8ca3-068fbfd97d4d_20250108T19:28_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 [PII], my name is [PII] and I'm calling for claim status.
[AGENT][NEUTRAL] May I have a callback number, please?
[CUSTOMER][NEUTRAL] Yep, it is [PII].
[AGENT][NEUTRAL] And you're calling from the provider's office?
[CUSTOMER][NEUTRAL] Facility.
[AGENT][NEUTRAL] OK. May I have the facility name, please?
[CUSTOMER][NEUTRAL] Stand up MRI and 3D imaging.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I please have the policy number?
[CUSTOMER][NEUTRAL] Uh-huh. Policy number of the patient is um.
[CUSTOMER][NEUTRAL] 01841157.
[CUSTOMER][NEUTRAL] M for mama, L for Lima, and the number 7.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for outpatient benefits verification of coverage does not guarantee the payment of the claim.
[AGENT][NEUTRAL] This member has up to $1000 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It will not cover any preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, I'm looking for a claim that for a date of service of [PII]. I'm wondering if you received it.
[AGENT][POSITIVE] Oh, OK, I apologize you're looking for.
[AGENT][NEUTRAL] That is, may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Date of service is [PII]. total bill is $1600.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that is for date of service of [PII]. Total bill charged $1600. It does show that we do have that claim on file. Let me get the receipt date and process date for you.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows that we did receive that on [PII] of [PII], we processed it on [PII]. That claim number is 349.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 2477, the claim process and it denied that the per calendar year max had been met.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that again?
[AGENT][NEUTRAL] The per calendar year max had been met, so the member had no more benefits for that year.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I see. Um, Tarika, um, can you fax me over this?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] EOB so that we can post it on the patient's account.
[AGENT][NEUTRAL] Yes, may I have the fax number?
[CUSTOMER][NEUTRAL] Uh-huh. Fax number is [PII].
[AGENT][NEUTRAL] And that is [PII].
[CUSTOMER][POSITIVE] That is right.
[AGENT][NEUTRAL] OK. And to the attention of [PII]?
[CUSTOMER][POSITIVE] Yeah, you, you can do that.
[AGENT][POSITIVE] OK, I will get that request submitted over for you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Just a call reference number if we have one.
[AGENT][NEUTRAL] The call reference will be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] Got it, thank you so much for your help um have a good day.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well.