AccountId: 011433970860
ContactId: ec5ce198-4e93-44ad-96fc-2f499e71fd0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163210 ms
Total Talk Time (AGENT): 90044 ms
Total Talk Time (CUSTOMER): 64471 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/ec5ce198-4e93-44ad-96fc-2f499e71fd0f_20250122T14:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, [PII], um, uh, I need to let you know that this call is being recorded for quality purposes. My name is [PII] and I am calling from Surgery Center of Fairfield County, and I'm calling with a question on the amount that we received um for payment on this claim.
[AGENT][NEUTRAL] I'll be happy to verify claim status, [PII]. May I have the policy number?
[CUSTOMER][NEUTRAL] 02476613
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. May I have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, data service, let me see claim number, let me see if it's on this EOB claim number is 35088778.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. So it looks like this claim processed on [PII]. It looks like patients responsibility.
[AGENT][NEUTRAL] was 1620.90. The benefit amount allowed 80812. It looks like the outpatient benefit max was met with this claim.
[CUSTOMER][NEUTRAL] OK, so the um, so they have a maximum benefit for, um, is it an ambulatory surgery center or at the any all the services rendered for that data service?
[AGENT][NEUTRAL] It is a calendar year, so the benefit amount allows outpatient calendar year $1000.
[AGENT][NEUTRAL] So from that $1000 808.12 was only available when this claim was received.
[CUSTOMER][NEUTRAL] OK, and the additional amount is the patient responsibility?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, alrighty, and do you use call reference numbers?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's everything. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too, bye.