AccountId: 011433970860
ContactId: ff69e207-aefa-43e9-acb4-12be6409a888
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277239 ms
Total Talk Time (AGENT): 139678 ms
Total Talk Time (CUSTOMER): 72890 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/ff69e207-aefa-43e9-acb4-12be6409a888_20250128T14:52_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. This is [PII] in customer service. I have a provider's office calling for a claim status on a patient.
[AGENT][NEUTRAL] OK, and what is that policy number?
[CUSTOMER][NEUTRAL] Policy number is 02549389.
[CUSTOMER][NEUTRAL] For Mr. Mr. [PII].
[AGENT][NEUTRAL] OK. And you verified his date of birth and
[CUSTOMER][NEUTRAL] I only verified his date of birth.
[AGENT][NEUTRAL] OK, and did you get his the callback number for the provider?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm, the one that they are calling from, the one ending in [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate it.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Here she goes.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Oh, her name is [PII].
[AGENT][POSITIVE] [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is [PII] in claims. Um, you're wanting to verify, um, verify claim status or benefits.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Uh, claim status.
[AGENT][NEUTRAL] OK. And uh [PII], is your callback number [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And this is on [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] [PII]. OK, thank you, [PII]. What is
[CUSTOMER][NEUTRAL] Yeah, it's changed.
[AGENT][NEUTRAL] And what is the um data service that you're calling on?
[CUSTOMER][NEUTRAL] 1217 24.
[AGENT][POSITIVE] OK, thank you, [PII]. I'll be happy to check that claim status for you. Just give me just a few minutes while I get um this uh policy pulled up for these benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, Coastal Carolina Medical Center.
[AGENT][NEUTRAL] OK. And how much was the charged amount?
[CUSTOMER][NEUTRAL] $13,954.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, this policy, uh, was, uh, or this, this, um, this claim was processed. We received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied.
[CUSTOMER][NEUTRAL] OK, why?
[AGENT][NEUTRAL] Because there's no outpatient, uh, benefits. This is a hospital indemnity policy. Um, there's no ER uh benefits or any, no benefits for an emergency room that's considered as an outpatient.
[AGENT][NEUTRAL] Only, only outpatient benefit is, is for surgery.
[AGENT][NEUTRAL] And hospital stay, but there's nothing for ER visits.
[CUSTOMER][NEUTRAL] OK, uh, so do they not have any other coverage?
[AGENT][NEUTRAL] I'm not sure. I'm not for, not with American Public Life cause we're not a major medical, we're just a supplemental policy. And I'm not sure if they have any major medical health insurance. They may, but I'm not sure if they do or not who it would be.
[CUSTOMER][NEUTRAL] For that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so we need to check with them to see if they have anything else. um, OK, I wonder why they only gave us that information and this is an ER visit. OK, um, can I get a um call reference number from you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can use today's date.
[AGENT][NEUTRAL] And my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] My pleasure. Anything else I can help you out with?
[CUSTOMER][POSITIVE] No, that's it. Have a great day, [PII].
[AGENT][POSITIVE] Oh, thank you, [PII]. You have a wonderful day. Thank you for calling American Public Life.
[CUSTOMER][NEUTRAL] Mhm bye bye.