AccountId: 011433970860
ContactId: fe6ec331-0090-42cb-9326-bb8c9b9b26d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280880 ms
Total Talk Time (AGENT): 92071 ms
Total Talk Time (CUSTOMER): 107988 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/fe6ec331-0090-42cb-9326-bb8c9b9b26d8_20250114T20:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Hi, [PII]. Good afternoon. My name is [PII] and I'm calling you from the facility. And I have a claim, and regarding that, I have questions, so please help me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII], so you have questions regarding a claim that has been processed, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] OK. It's going to be.
[CUSTOMER][NEUTRAL] Oh, give me a second. Actually, my system is still loading the pages. OK, here I.
[AGENT][POSITIVE] OK, that's fine. No worries.
[CUSTOMER][NEUTRAL] Policy number is 02407896.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Um, that's OK.
[AGENT][NEUTRAL] And any information, [PII], that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient name I have is [PII]. Date of birth February, sorry. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you
[CUSTOMER][NEUTRAL] OK. Can I have your name once again?
[AGENT][NEUTRAL] And [PII], what is [PII]?
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Let's proceed.
[AGENT][NEUTRAL] And [PII], what is, uh-huh, what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The service I have for this patient, [PII], with the total charge amount of
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $10,547 even.
[AGENT][NEUTRAL] Thank you and the claim number?
[CUSTOMER][NEUTRAL] OK, the claim number I have in question is.
[CUSTOMER][NEUTRAL] 3505929
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Just give me a moment, [PII], to get that information pulled up.
[AGENT][NEUTRAL] You said 3505929. Is that correct?
[CUSTOMER][NEUTRAL] No, it's 3505929.
[AGENT][NEUTRAL] Yes, so that's what I said.
[AGENT][POSITIVE] Is that correct? That is correct.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and how can I help you today with that claim?
[CUSTOMER][NEUTRAL] OK, thank you for asking. As I'm looking here, we have submitted this claim to the American Public Life Insurance Company with the primary explanation of payment or explanation of benefit in which primary applied $700 towards the co-payment for the member responsibility.
[CUSTOMER][NEGATIVE] So, we were expecting you to get uh to pay this claim for $700 but the only allowed amount or the paid amount is $450 even.
[AGENT][NEUTRAL] OK, this
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And with that payment, the max
[CUSTOMER][NEGATIVE] And this claim is still underpaid by $250 even.
[AGENT][NEUTRAL] With this check, the maximum benefit payable for this state of service has been met.
[AGENT][NEUTRAL] The maximum benefit for covered outpatient services per calendar day on this supplemental policy is $500.
[AGENT][NEUTRAL] There was another claim that was processed.
[AGENT][NEUTRAL] And then the $450 payment that was issued on this claim was the max benefit payable.