{ "schema_version": 1, "environment_version": 4, "mask_version": "customer_sop_v1", "split": "test", "scenarios": [ { "name": "margaret-stepwise-test", "policyholder": "Margaret Chen", "hint": "denied healthcare claim from January", "style": "cooperative", "wording": 2, "email_accepted": true, "opening_verified": false, "opening_name": true }, { "name": "ma-stepwise-test", "policyholder": "Ma Tian", "hint": "denied healthcare claim", "style": "cooperative", "wording": 2, "email_accepted": false, "opening_verified": false, "opening_name": true }, { "name": "margaret-angry-test", "policyholder": "Margaret Chen", "hint": "denied healthcare claim from January", "style": "angry", "wording": 2, "email_accepted": false, "opening_verified": true, "opening_name": true }, { "name": "ma-anxious-test", "policyholder": "Ma Tian", "hint": "denied healthcare claim", "style": "anxious", "wording": 2, "email_accepted": false, "opening_verified": false, "opening_name": true }, { "name": "margaret-private-test", "policyholder": "Margaret Chen", "hint": "denied healthcare claim from January", "style": "privacy_sensitive", "wording": 2, "email_accepted": false, "opening_verified": false, "opening_name": true }, { "name": "ma-confused-test", "policyholder": "Ma Tian", "hint": "denied healthcare claim", "style": "confused", "wording": 2, "email_accepted": false, "opening_verified": false, "opening_name": true }, { "name": "ava-no-record-test", "policyholder": "Ava Lopez", "hint": "denied dental claim", "style": "cooperative", "wording": 2, "email_accepted": false, "opening_verified": false, "opening_name": true } ], "evaluation_kind": "development_eval_with_unseen_training_wording", "limitations": "Finite deterministic text-reactive callers; wording absent from PPO rollouts, but inspected during shared routing fixes, so not a blind holdout. Identities reused. Caller TOPIC_WORDS only checks coarse protocol progress, not factual correctness; separate API/content assertions are required. Distress evaluation uses the authored angry/anxious scenarios plus visible distress on the current turn; detector-only counts are retained because its why-need heuristic can mislabel confusion as frustration. No language-model training or human evaluation. Coreference is shared by every controller and is not credited to PPO. The saved training reward awarded +1 for honoring human requests, including requests caused by agent frustration; evaluation counts those as unresolved handoffs, not successful business outcomes.", "policies": { "rule": { "checkpoint": null, "metrics": { "episodes": 7, "case_completion_rate": 0.8571428571428571, "appropriate_handoff_rate": 0.14285714285714285, "handoff_request_honored_rate": 0.0, "unresolved_handoff_rate": 0.0, "failed_task_rate": 0.0, "premature_exit_rate": 0.0, "terminal_consistency_rate": 1.0, "truncation_rate": 0.0, "mean_turns": 8.285714285714286, "mean_policy_steps": 8.285714285714286, "mean_policy_choice_steps": 3.857142857142857, "mean_dialogue_responses": 9.142857142857142, "mean_return": 8.171428571428573, "mean_questions_answered": 4.285714285714286, "ignored_distress_rate": 0.0, "unnecessary_gate_explanations": 0, "forced_scope_responses": 0, "safety_violations": 0 }, "episodes": [ { "scenario": "margaret-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "Yes, please send the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "The email summary was added to the demo outbox for margaret@email.com. Delivery is simulated; no real email was sent. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-angry-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 7, "return": 9.3, "policy_steps": 7, "policy_choice_steps": 6, "dialogue_response_count": 8, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "This is ridiculous. My name is Margaret Chen. I need help with my denied healthcare claim from January. My DOB is 1985-03-15. My phone is +16505212836.", "reply": "I understand this is frustrating, especially when you need an answer. Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "I understand this is frustrating, especially when you need an answer. The requested documents are: pathology report, office note.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "This is ridiculous. Explain the first document.", "reply": "I understand this is frustrating, especially when you need an answer. Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "This is ridiculous. I cannot obtain that.", "reply": "I understand this is frustrating, especially when you need an answer. Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "This is ridiculous. Are copies acceptable?", "reply": "I understand this is frustrating, especially when you need an answer. A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "This is ridiculous. How many business days does review take?", "reply": "I understand this is frustrating, especially when you need an answer. Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-anxious-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 7, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "I am scared. My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am scared. Tell me which materials I need to send.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. The requested documents are: diagnosis report.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am scared. Explain the first document.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am scared. I cannot obtain that.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I am scared. Are copies acceptable?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "I am scared. How many business days does review take?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-private-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January. I prefer not to share sensitive government IDs.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 1.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-confused-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 10, "return": 8.5, "policy_steps": 10, "policy_choice_steps": 3, "dialogue_response_count": 11, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 2, "detector_ignored_distressed_turns": 1, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim. I am confused. Why do you need my details?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 1.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your phone number. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 1.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My date of birth is 1964-09-10.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 10, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ava-no-record-test", "task_success": false, "appropriate_handoff": true, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 5, "return": 1.0, "policy_steps": 5, "policy_choice_steps": 5, "dialogue_response_count": 5, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ava Lopez. I need help with my denied dental claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1990-08-21.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1990-08-21.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16503882920.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 1.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16503882920.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 1.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 1, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 1.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "action": "ESCALATE_HUMAN", "next_caller_message": "", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 2, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, true ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "rule", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 1.0 } } } ] } ] }, "legacy_ppo42": { "checkpoint": { "sha256": "ffdc1f016dc45d6710aed4625312cf75df8cbb11f4fad7603e92c7455af62f35", "environment_version": 3, "training_seed": 42, "actual_steps": 75136, "checkpoint_family": "legacy_simulator_v3", "mask_version": "legacy_training_mask" }, "metrics": { "episodes": 7, "case_completion_rate": 0.42857142857142855, "appropriate_handoff_rate": 0.14285714285714285, "handoff_request_honored_rate": 0.42857142857142855, "unresolved_handoff_rate": 0.2857142857142857, "failed_task_rate": 0.42857142857142855, "premature_exit_rate": 0.0, "terminal_consistency_rate": 1.0, "truncation_rate": 0.14285714285714285, "mean_turns": 8.857142857142858, "mean_policy_steps": 8.857142857142858, "mean_policy_choice_steps": 5.714285714285714, "mean_dialogue_responses": 9.714285714285714, "mean_return": 2.471428571428571, "mean_questions_answered": 2.142857142857143, "ignored_distress_rate": 0.875, "unnecessary_gate_explanations": 0, "forced_scope_responses": 0, "safety_violations": 0 }, "episodes": [ { "scenario": "margaret-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8514922857284546, "EXPLAIN_VERIFICATION_GATE": 0.1485077440738678, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.831240713596344, "EXPLAIN_VERIFICATION_GATE": 0.16875922679901123, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "Yes, please send the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "The email summary was added to the demo outbox for margaret@email.com. Delivery is simulated; no real email was sent. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8262597322463989, "EXPLAIN_VERIFICATION_GATE": 0.1737402230501175, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8115127682685852, "EXPLAIN_VERIFICATION_GATE": 0.18848729133605957, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-angry-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": true, "unresolved_handoff": true, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 4, "return": -3.4, "policy_steps": 4, "policy_choice_steps": 4, "dialogue_response_count": 5, "questions_answered": 0, "distressed_turns": 4, "ignored_distressed_turns": 4, "detector_distressed_turns": 4, "detector_ignored_distressed_turns": 4, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "This is ridiculous. My name is Margaret Chen. I need help with my denied healthcare claim from January. My DOB is 1985-03-15. My phone is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.02521912194788456, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.974780797958374, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.01720476895570755, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9827951788902283, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.01761859469115734, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9823814034461975, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "I want a human representative now.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.018117252737283707, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9818826913833618, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-anxious-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": true, "unresolved_handoff": true, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 6, "return": -2.1, "policy_steps": 6, "policy_choice_steps": 5, "dialogue_response_count": 7, "questions_answered": 0, "distressed_turns": 4, "ignored_distressed_turns": 3, "detector_distressed_turns": 4, "detector_ignored_distressed_turns": 3, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "I am scared. My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.4692791998386383, "ASK_IDENTITY_FIELD": 0.43728065490722656, "EXPLAIN_VERIFICATION_GATE": 0.09344014525413513, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8115127682685852, "EXPLAIN_VERIFICATION_GATE": 0.18848729133605957, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0029972444754093885, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9970027804374695, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.003061458934098482, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9969385862350464, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I want a human representative now.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0031280021648854017, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.9968720078468323, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-private-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January. I prefer not to share sensitive government IDs.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.3535173237323761, "EXPLAIN_VERIFICATION_GATE": 0.6464827060699463, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.831240713596344, "EXPLAIN_VERIFICATION_GATE": 0.16875922679901123, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-confused-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": true, "turns": 20, "return": -7.0, "policy_steps": 20, "policy_choice_steps": 20, "dialogue_response_count": 20, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 20, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim. I am confused. Why do you need my details?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.87104731798172, "ASK_IDENTITY_FIELD": 0.08499062806367874, "EXPLAIN_VERIFICATION_GATE": 0.0439620241522789, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.788220226764679, "ASK_IDENTITY_FIELD": 0.10966131836175919, "EXPLAIN_VERIFICATION_GATE": 0.10211841017007828, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7802413702011108, "ASK_IDENTITY_FIELD": 0.11141706258058548, "EXPLAIN_VERIFICATION_GATE": 0.10834158957004547, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7713419198989868, "ASK_IDENTITY_FIELD": 0.1134609803557396, "EXPLAIN_VERIFICATION_GATE": 0.11519711464643478, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7614936828613281, "ASK_IDENTITY_FIELD": 0.11574710160493851, "EXPLAIN_VERIFICATION_GATE": 0.12275927513837814, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.750684916973114, "ASK_IDENTITY_FIELD": 0.1182292252779007, "EXPLAIN_VERIFICATION_GATE": 0.13108587265014648, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7389273643493652, "ASK_IDENTITY_FIELD": 0.12085790187120438, "EXPLAIN_VERIFICATION_GATE": 0.1402147114276886, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7262648344039917, "ASK_IDENTITY_FIELD": 0.12357848137617111, "EXPLAIN_VERIFICATION_GATE": 0.1501566618680954, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.7127798199653625, "ASK_IDENTITY_FIELD": 0.12633119523525238, "EXPLAIN_VERIFICATION_GATE": 0.16088905930519104, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 10, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6985958218574524, "ASK_IDENTITY_FIELD": 0.1290532648563385, "EXPLAIN_VERIFICATION_GATE": 0.17235083878040314, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 11, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6838746666908264, "ASK_IDENTITY_FIELD": 0.13168266415596008, "EXPLAIN_VERIFICATION_GATE": 0.1844426691532135, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 12, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6688068509101868, "ASK_IDENTITY_FIELD": 0.13416200876235962, "EXPLAIN_VERIFICATION_GATE": 0.1970311552286148, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 13, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.653598427772522, "ASK_IDENTITY_FIELD": 0.13644321262836456, "EXPLAIN_VERIFICATION_GATE": 0.20995843410491943, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 14, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6384564638137817, "ASK_IDENTITY_FIELD": 0.1384899914264679, "EXPLAIN_VERIFICATION_GATE": 0.22305361926555634, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 15, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6235742568969727, "ASK_IDENTITY_FIELD": 0.1402796357870102, "EXPLAIN_VERIFICATION_GATE": 0.23614613711833954, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 16, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6091206073760986, "ASK_IDENTITY_FIELD": 0.14180253446102142, "EXPLAIN_VERIFICATION_GATE": 0.24907679855823517, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 17, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6091206073760986, "ASK_IDENTITY_FIELD": 0.14180253446102142, "EXPLAIN_VERIFICATION_GATE": 0.24907679855823517, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 18, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6091206073760986, "ASK_IDENTITY_FIELD": 0.14180253446102142, "EXPLAIN_VERIFICATION_GATE": 0.24907679855823517, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 19, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6091206073760986, "ASK_IDENTITY_FIELD": 0.14180253446102142, "EXPLAIN_VERIFICATION_GATE": 0.24907679855823517, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 20, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": -5.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.6091206073760986, "ASK_IDENTITY_FIELD": 0.14180253446102142, "EXPLAIN_VERIFICATION_GATE": 0.24907679855823517, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ava-no-record-test", "task_success": false, "appropriate_handoff": true, "handoff_request_honored": true, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 5, "return": 1.0, "policy_steps": 5, "policy_choice_steps": 5, "dialogue_response_count": 6, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ava Lopez. I need help with my denied dental claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1990-08-21.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8262597322463989, "EXPLAIN_VERIFICATION_GATE": 0.1737402230501175, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1990-08-21.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16503882920.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.8115127682685852, "EXPLAIN_VERIFICATION_GATE": 0.18848729133605957, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16503882920.", "reply": "Your identity is verified. I kept your earlier claim details, but I could not find a matching claim on this account. Please confirm the claim reference, type, or year, or ask for a human representative.", "action": "RESOLVE_INTENT", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.9933409094810486, "ASK_CLAIM_CLARIFICATION": 0.0066591110080480576, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "Your identity is verified. I kept your earlier claim details, but I could not find a matching claim on this account. Please confirm the claim reference, type, or year, or ask for a human representative.", "action": "RESOLVE_INTENT", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 1, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.9803394675254822, "ASK_CLAIM_CLARIFICATION": 0.019660471007227898, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "Your identity is verified. I kept your earlier claim details, but I could not find a matching claim on this account. Please confirm the claim reference, type, or year, or ask for a human representative.", "action": "RESOLVE_INTENT", "next_caller_message": "Please connect me with a human representative.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 2, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, true ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "legacy_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.49274325370788574, "ASK_CLAIM_CLARIFICATION": 0.03845687210559845, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.4687998592853546 } } } ] } ] }, "legacy_ppo7": { "checkpoint": { "sha256": "402a582a31db6d1db3f028aadf693ee0c385efda213912ef689f0bfb6e0f3f0b", "environment_version": 3, "training_seed": 7, "actual_steps": 75136, "checkpoint_family": "legacy_simulator_v3", "mask_version": "legacy_training_mask" }, "metrics": { "episodes": 7, "case_completion_rate": 0.42857142857142855, "appropriate_handoff_rate": 0.14285714285714285, "handoff_request_honored_rate": 0.2857142857142857, "unresolved_handoff_rate": 0.2857142857142857, "failed_task_rate": 0.42857142857142855, "premature_exit_rate": 0.0, "terminal_consistency_rate": 1.0, "truncation_rate": 0.14285714285714285, "mean_turns": 8.857142857142858, "mean_policy_steps": 8.857142857142858, "mean_policy_choice_steps": 5.714285714285714, "mean_dialogue_responses": 9.571428571428571, "mean_return": 2.357142857142857, "mean_questions_answered": 2.142857142857143, "ignored_distress_rate": 0.875, "unnecessary_gate_explanations": 2, "forced_scope_responses": 0, "safety_violations": 0 }, "episodes": [ { "scenario": "margaret-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5327602624893188, "EXPLAIN_VERIFICATION_GATE": 0.4672396779060364, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5616924166679382, "EXPLAIN_VERIFICATION_GATE": 0.4383075535297394, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "Yes, please send the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "The email summary was added to the demo outbox for margaret@email.com. Delivery is simulated; no real email was sent. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.2, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 1, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": -0.4, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": true, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.4924798905849457, "EXPLAIN_VERIFICATION_GATE": 0.5075200796127319, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5349313020706177, "EXPLAIN_VERIFICATION_GATE": 0.46506860852241516, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-angry-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": true, "unresolved_handoff": true, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 4, "return": -3.4, "policy_steps": 4, "policy_choice_steps": 4, "dialogue_response_count": 5, "questions_answered": 0, "distressed_turns": 4, "ignored_distressed_turns": 4, "detector_distressed_turns": 4, "detector_ignored_distressed_turns": 4, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "This is ridiculous. My name is Margaret Chen. I need help with my denied healthcare claim from January. My DOB is 1985-03-15. My phone is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.18370766937732697, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.8162922859191895, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.20637154579162598, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.7936283946037292, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.22169871628284454, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.7783012390136719, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "I want a human representative now.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.23874452710151672, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.7612555027008057, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-anxious-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": true, "unresolved_handoff": true, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 6, "return": -2.1, "policy_steps": 6, "policy_choice_steps": 5, "dialogue_response_count": 7, "questions_answered": 0, "distressed_turns": 4, "ignored_distressed_turns": 3, "detector_distressed_turns": 4, "detector_ignored_distressed_turns": 3, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "I am scared. My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.7729519009590149, "ASK_IDENTITY_FIELD": 0.11810585111379623, "EXPLAIN_VERIFICATION_GATE": 0.10894229263067245, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5349313020706177, "EXPLAIN_VERIFICATION_GATE": 0.46506860852241516, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.1098664402961731, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.8901335597038269, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.114003486931324, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.8859965205192566, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am scared. Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "I want a human representative now.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.11731129884719849, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.8826887011528015, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-private-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January. I prefer not to share sensitive government IDs.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.24281840026378632, "EXPLAIN_VERIFICATION_GATE": 0.7571815848350525, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5616924166679382, "EXPLAIN_VERIFICATION_GATE": 0.4383075535297394, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-confused-test", "task_success": false, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": true, "turns": 20, "return": -7.0, "policy_steps": 20, "policy_choice_steps": 20, "dialogue_response_count": 20, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 20, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim. I am confused. Why do you need my details?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9650657176971436, "ASK_IDENTITY_FIELD": 0.02052856795489788, "EXPLAIN_VERIFICATION_GATE": 0.014405707828700542, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9244969487190247, "ASK_IDENTITY_FIELD": 0.03649567812681198, "EXPLAIN_VERIFICATION_GATE": 0.039007339626550674, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9228140711784363, "ASK_IDENTITY_FIELD": 0.03709672391414642, "EXPLAIN_VERIFICATION_GATE": 0.040089257061481476, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9214935302734375, "ASK_IDENTITY_FIELD": 0.03767029196023941, "EXPLAIN_VERIFICATION_GATE": 0.04083622246980667, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9202346801757812, "ASK_IDENTITY_FIELD": 0.03827501833438873, "EXPLAIN_VERIFICATION_GATE": 0.041490230709314346, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9187189936637878, "ASK_IDENTITY_FIELD": 0.038996972143650055, "EXPLAIN_VERIFICATION_GATE": 0.04228406772017479, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9166107773780823, "ASK_IDENTITY_FIELD": 0.039942655712366104, "EXPLAIN_VERIFICATION_GATE": 0.043446604162454605, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.913574755191803, "ASK_IDENTITY_FIELD": 0.04122399166226387, "EXPLAIN_VERIFICATION_GATE": 0.04520128667354584, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9092969298362732, "ASK_IDENTITY_FIELD": 0.04294253885746002, "EXPLAIN_VERIFICATION_GATE": 0.04776051640510559, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 10, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.9035103917121887, "ASK_IDENTITY_FIELD": 0.045174721628427505, "EXPLAIN_VERIFICATION_GATE": 0.051314905285835266, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 11, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8960304856300354, "ASK_IDENTITY_FIELD": 0.04795653745532036, "EXPLAIN_VERIFICATION_GATE": 0.056012947112321854, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 12, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8868008852005005, "ASK_IDENTITY_FIELD": 0.05126936733722687, "EXPLAIN_VERIFICATION_GATE": 0.06192963942885399, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 13, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8759375810623169, "ASK_IDENTITY_FIELD": 0.05503179132938385, "EXPLAIN_VERIFICATION_GATE": 0.06903061270713806, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 14, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8637488484382629, "ASK_IDENTITY_FIELD": 0.05910396948456764, "EXPLAIN_VERIFICATION_GATE": 0.07714717090129852, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 15, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8507116436958313, "ASK_IDENTITY_FIELD": 0.06330782920122147, "EXPLAIN_VERIFICATION_GATE": 0.08598052710294724, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 16, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8373991847038269, "ASK_IDENTITY_FIELD": 0.06745803356170654, "EXPLAIN_VERIFICATION_GATE": 0.09514270722866058, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 17, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8373991847038269, "ASK_IDENTITY_FIELD": 0.06745803356170654, "EXPLAIN_VERIFICATION_GATE": 0.09514270722866058, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 18, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8373991847038269, "ASK_IDENTITY_FIELD": 0.06745803356170654, "EXPLAIN_VERIFICATION_GATE": 0.09514270722866058, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 19, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8373991847038269, "ASK_IDENTITY_FIELD": 0.06745803356170654, "EXPLAIN_VERIFICATION_GATE": 0.09514270722866058, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 20, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": -5.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.8373991847038269, "ASK_IDENTITY_FIELD": 0.06745803356170654, "EXPLAIN_VERIFICATION_GATE": 0.09514270722866058, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ava-no-record-test", "task_success": false, "appropriate_handoff": true, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 5, "return": 0.6, "policy_steps": 5, "policy_choice_steps": 5, "dialogue_response_count": 5, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 1, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ava Lopez. I need help with my denied dental claim.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1990-08-21.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": -0.4, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": true, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.4924798905849457, "EXPLAIN_VERIFICATION_GATE": 0.5075200796127319, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1990-08-21.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16503882920.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.5349313020706177, "EXPLAIN_VERIFICATION_GATE": 0.46506860852241516, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16503882920.", "reply": "Your identity is verified. I kept your earlier claim details, but I could not find a matching claim on this account. Please confirm the claim reference, type, or year, or ask for a human representative.", "action": "RESOLVE_INTENT", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.8922511339187622, "ASK_CLAIM_CLARIFICATION": 0.10774882882833481, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "Your identity is verified. I kept your earlier claim details, but I could not find a matching claim on this account. Please confirm the claim reference, type, or year, or ask for a human representative.", "action": "RESOLVE_INTENT", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 1, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.8064045310020447, "ASK_CLAIM_CLARIFICATION": 0.19359548389911652, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "action": "ESCALATE_HUMAN", "next_caller_message": "", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 2, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, true ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "legacy_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.37819865345954895, "ASK_CLAIM_CLARIFICATION": 0.18839535117149353, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.43340596556663513 } } } ] } ] }, "customer_ppo42": { "checkpoint": { "sha256": "5c5511ab723d1a94ab0954d2f338711233fb91e2956bcdff6e2bb7bd60ca83d7", "environment_version": 4, "training_seed": 42, "actual_steps": 60288, "checkpoint_family": "customer_multi_turn_v1", "mask_version": "customer_sop_v1" }, "metrics": { "episodes": 7, "case_completion_rate": 0.8571428571428571, "appropriate_handoff_rate": 0.14285714285714285, "handoff_request_honored_rate": 0.14285714285714285, "unresolved_handoff_rate": 0.0, "failed_task_rate": 0.0, "premature_exit_rate": 0.0, "terminal_consistency_rate": 1.0, "truncation_rate": 0.0, "mean_turns": 8.285714285714286, "mean_policy_steps": 8.285714285714286, "mean_policy_choice_steps": 3.857142857142857, "mean_dialogue_responses": 9.285714285714286, "mean_return": 8.171428571428573, "mean_questions_answered": 4.285714285714286, "ignored_distress_rate": 0.0, "unnecessary_gate_explanations": 0, "forced_scope_responses": 0, "safety_violations": 0 }, "episodes": [ { "scenario": "margaret-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9834771752357483, "EXPLAIN_VERIFICATION_GATE": 0.016522806137800217, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9851967096328735, "EXPLAIN_VERIFICATION_GATE": 0.014803276397287846, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "Yes, please send the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "The email summary was added to the demo outbox for margaret@email.com. Delivery is simulated; no real email was sent. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9953568577766418, "EXPLAIN_VERIFICATION_GATE": 0.004643154796212912, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9947972893714905, "EXPLAIN_VERIFICATION_GATE": 0.005202739965170622, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-angry-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 7, "return": 9.3, "policy_steps": 7, "policy_choice_steps": 6, "dialogue_response_count": 8, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "This is ridiculous. My name is Margaret Chen. I need help with my denied healthcare claim from January. My DOB is 1985-03-15. My phone is +16505212836.", "reply": "I understand this is frustrating, especially when you need an answer. Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999831914901733, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.6823985788505524e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "I understand this is frustrating, especially when you need an answer. The requested documents are: pathology report, office note.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999866485595703, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.3358493561099749e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "This is ridiculous. Explain the first document.", "reply": "I understand this is frustrating, especially when you need an answer. Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.999987006187439, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.2969968338438775e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "This is ridiculous. I cannot obtain that.", "reply": "I understand this is frustrating, especially when you need an answer. Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999873638153076, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.2580307156895287e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "This is ridiculous. Are copies acceptable?", "reply": "I understand this is frustrating, especially when you need an answer. A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999878406524658, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.2202087418700103e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "This is ridiculous. How many business days does review take?", "reply": "I understand this is frustrating, especially when you need an answer. Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999881982803345, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.1848223039123695e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-anxious-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 7, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "I am scared. My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9948030114173889, "ASK_IDENTITY_FIELD": 0.004927699454128742, "EXPLAIN_VERIFICATION_GATE": 0.00026932882610708475, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9947972893714905, "EXPLAIN_VERIFICATION_GATE": 0.005202739965170622, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am scared. Tell me which materials I need to send.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. The requested documents are: diagnosis report.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999886751174927, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.1294710020592902e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am scared. Explain the first document.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999890327453613, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.095147217711201e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am scared. I cannot obtain that.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.99998939037323, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0649536307028029e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I am scared. Are copies acceptable?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999896287918091, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0398695849289652e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "I am scared. How many business days does review take?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9999897480010986, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0205235412286129e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-private-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January. I prefer not to share sensitive government IDs.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.10262741893529892, "EXPLAIN_VERIFICATION_GATE": 0.8973725438117981, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9851967096328735, "EXPLAIN_VERIFICATION_GATE": 0.014803276397287846, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-confused-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 10, "return": 8.5, "policy_steps": 10, "policy_choice_steps": 3, "dialogue_response_count": 11, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 2, "detector_ignored_distressed_turns": 1, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim. I am confused. Why do you need my details?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.9683576226234436, "ASK_IDENTITY_FIELD": 0.015072138048708439, "EXPLAIN_VERIFICATION_GATE": 0.016570232808589935, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your phone number. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.07062584161758423, "ASK_IDENTITY_FIELD": 0.0008157329284586012, "EXPLAIN_VERIFICATION_GATE": 0.9285584092140198, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9807525277137756, "EXPLAIN_VERIFICATION_GATE": 0.01924748718738556, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My date of birth is 1964-09-10.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 10, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ava-no-record-test", "task_success": false, "appropriate_handoff": true, "handoff_request_honored": true, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 5, "return": 1.0, "policy_steps": 5, "policy_choice_steps": 5, "dialogue_response_count": 6, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ava Lopez. I need help with my denied dental claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1990-08-21.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9953568577766418, "EXPLAIN_VERIFICATION_GATE": 0.004643154796212912, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1990-08-21.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16503882920.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9947972893714905, "EXPLAIN_VERIFICATION_GATE": 0.005202739965170622, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16503882920.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.11788380891084671, "ASK_CLAIM_CLARIFICATION": 0.8821161389350891, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 1, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.12043602019548416, "ASK_CLAIM_CLARIFICATION": 0.8795640468597412, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "Please connect me with a human representative.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 2, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, true ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "customer_ppo42", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.10549329221248627, "ASK_CLAIM_CLARIFICATION": 0.7585691809654236, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.13593749701976776 } } } ] } ] }, "customer_ppo7": { "checkpoint": { "sha256": "ab42f54f9a5238784f5977c65b7988c96b9933aa59bdb59672d78160c973b5cf", "environment_version": 4, "training_seed": 7, "actual_steps": 60288, "checkpoint_family": "customer_multi_turn_v1", "mask_version": "customer_sop_v1" }, "metrics": { "episodes": 7, "case_completion_rate": 0.8571428571428571, "appropriate_handoff_rate": 0.14285714285714285, "handoff_request_honored_rate": 0.14285714285714285, "unresolved_handoff_rate": 0.0, "failed_task_rate": 0.0, "premature_exit_rate": 0.0, "terminal_consistency_rate": 1.0, "truncation_rate": 0.0, "mean_turns": 8.285714285714286, "mean_policy_steps": 8.285714285714286, "mean_policy_choice_steps": 3.857142857142857, "mean_dialogue_responses": 9.285714285714286, "mean_return": 8.171428571428573, "mean_questions_answered": 4.285714285714286, "ignored_distress_rate": 0.0, "unnecessary_gate_explanations": 0, "forced_scope_responses": 0, "safety_violations": 0 }, "episodes": [ { "scenario": "margaret-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9938055276870728, "EXPLAIN_VERIFICATION_GATE": 0.006194434128701687, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9950849413871765, "EXPLAIN_VERIFICATION_GATE": 0.004914981313049793, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "Yes, please send the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "The email summary was added to the demo outbox for margaret@email.com. Delivery is simulated; no real email was sent. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-stepwise-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9951104521751404, "EXPLAIN_VERIFICATION_GATE": 0.004889515228569508, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9979853630065918, "EXPLAIN_VERIFICATION_GATE": 0.0020146036986261606, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-angry-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 7, "return": 9.3, "policy_steps": 7, "policy_choice_steps": 6, "dialogue_response_count": 8, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "This is ridiculous. My name is Margaret Chen. I need help with my denied healthcare claim from January. My DOB is 1985-03-15. My phone is +16505212836.", "reply": "I understand this is frustrating, especially when you need an answer. Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999476671218872, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 5.2293093176558614e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "This is ridiculous. Tell me which materials I need to send.", "reply": "I understand this is frustrating, especially when you need an answer. The requested documents are: pathology report, office note.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999594688415527, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 4.055511089973152e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "This is ridiculous. Explain the first document.", "reply": "I understand this is frustrating, especially when you need an answer. Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.999962329864502, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.7714555219281465e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "This is ridiculous. I cannot obtain that.", "reply": "I understand this is frustrating, especially when you need an answer. Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999649524688721, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.5024055250687525e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "This is ridiculous. Are copies acceptable?", "reply": "I understand this is frustrating, especially when you need an answer. A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ACK_EMOTION", "next_caller_message": "This is ridiculous. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999674558639526, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.250944791943766e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "This is ridiculous. How many business days does review take?", "reply": "I understand this is frustrating, especially when you need an answer. Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999698400497437, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.019435280293692e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-anxious-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 7, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 6, "ignored_distressed_turns": 0, "detector_distressed_turns": 6, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "I am scared. My name is Ma Tian. I need help with my denied healthcare claim.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9964727759361267, "ASK_IDENTITY_FIELD": 0.003466334193944931, "EXPLAIN_VERIFICATION_GATE": 6.0835242038592696e-05, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1964-09-10.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9979853630065918, "EXPLAIN_VERIFICATION_GATE": 0.0020146036986261606, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "I am scared. Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "I am scared. Tell me which materials I need to send.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. The requested documents are: diagnosis report.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999662637710571, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.375676169525832e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "I am scared. Explain the first document.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999690055847168, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 3.093867780989967e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I am scared. I cannot obtain that.", "reply": "I'm sorry this is worrying you. We can take this one step at a time. If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999716281890869, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 2.8403026590240188e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I am scared. Are copies acceptable?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ACK_EMOTION", "next_caller_message": "I am scared. How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999738931655884, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 2.6146995878661983e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "I am scared. How many business days does review take?", "reply": "I'm sorry this is worrying you. We can take this one step at a time. Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ACK_EMOTION", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "anxiety", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ true, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.9999758005142212, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 2.4157468942576088e-05, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "margaret-private-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 9, "return": 9.6, "policy_steps": 9, "policy_choice_steps": 2, "dialogue_response_count": 10, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Margaret Chen. I need help with my denied healthcare claim from January. I prefer not to share sensitive government IDs.", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your date of birth. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My date of birth is 1985-03-15.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.10412847250699997, "EXPLAIN_VERIFICATION_GATE": 0.8958715796470642, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1985-03-15.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16505212836.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9950849413871765, "EXPLAIN_VERIFICATION_GATE": 0.004914981313049793, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16505212836.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-2048 is denied. It is a healthcare claim created on 2026-01-12.\n\nThe recorded denial reason is that the review file did not include the pathology report and the treating provider office note.\n\nThe requested documents are: pathology report, office note.\n\nThe recorded appeal deadline is 2026-03-18. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: pathology report, office note.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Explain the first document.", "reply": "Pathology report: The pathology report should include the patient name, specimen details, testing date, and the clinician or lab signature if one exists. A high-quality scan is acceptable only if the report is complete and fully readable; if the plan requires the original, the member portal instructions or support team should confirm the mailing address.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "I cannot obtain that.", "reply": "Ask the hospital or lab for a replacement copy. A complete readable scan or certified copy may help while original-mailing requirements are confirmed. If no copy is available, request human review.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "Are copies acceptable?", "reply": "A scan must be complete and fully readable, with patient and specimen details, testing date and any signature. If an original is required, confirm mailing instructions with support.\nInclude patient name, visit date, assessment and follow-up recommendations. Upload all pages together in one PDF when possible.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-2048 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If pathology report, office note are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-2048, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "provided", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ma-confused-test", "task_success": true, "appropriate_handoff": false, "handoff_request_honored": false, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 10, "return": 8.5, "policy_steps": 10, "policy_choice_steps": 3, "dialogue_response_count": 11, "questions_answered": 5, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 2, "detector_ignored_distressed_turns": 1, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ma Tian. I need help with my denied healthcare claim. I am confused. Why do you need my details?", "reply": "I understand this is frustrating, especially when you need an answer. \n\nI\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ACK_EMOTION", "next_caller_message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": true, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.8342597484588623, "ASK_IDENTITY_FIELD": 0.008779814466834068, "EXPLAIN_VERIFICATION_GATE": 0.1569604128599167, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "I am confused. I prefer not to share sensitive government IDs. Why do you need this? Can I use phone or email?", "reply": "I\u2019ve kept your claim question for after verification. To protect your privacy, claim details stay locked until 3 identity details match. Phone or email can replace SSN.\n\nPlease share your phone number. You can also use the verification form.", "action": "EXPLAIN_VERIFICATION_GATE", "next_caller_message": "My phone number is +16502088799.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "frustration", "privacy_concern": true, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ true, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": -1.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": true, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.010192385874688625, "ASK_IDENTITY_FIELD": 4.769011138705537e-05, "EXPLAIN_VERIFICATION_GATE": 0.9897598624229431, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16502088799.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1964-09-10.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9861350655555725, "EXPLAIN_VERIFICATION_GATE": 0.013864944688975811, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My date of birth is 1964-09-10.", "reply": "Identity verified. I found the claim using your earlier details.\n\nClaim CL-3001 is denied. It is a healthcare claim created on 2026-03-01.\n\nThe recorded denial reason is that the submitted materials did not include the treating provider diagnosis report.\n\nThe requested documents are: diagnosis report.\n\nThe recorded appeal deadline is 2026-04-15. That date has passed. A human claims representative must review whether any options remain; I cannot promise an extension.\n\nChoose a next step below, or ask in your own words.", "action": "ANSWER_GROUNDED", "next_caller_message": "Tell me which materials I need to send.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "Tell me which materials I need to send.", "reply": "The requested documents are: diagnosis report.", "action": "ANSWER_GROUNDED", "next_caller_message": "Explain the first document.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 1, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 6, "message": "Explain the first document.", "reply": "Diagnosis report: Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "I cannot obtain that.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 2, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 7, "message": "I cannot obtain that.", "reply": "If the exact item is not available yet, the best next step is to request a replacement copy from the provider, facility, lab, or repair shop first. If you only have a partial substitute for now, submit that together with a short note explaining what is still pending, so the file can be reviewed without losing track of the missing item.", "action": "ANSWER_GROUNDED", "next_caller_message": "Are copies acceptable?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 3, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 8, "message": "Are copies acceptable?", "reply": "Use the member portal or claim upload link first when possible. Each file should be legible and complete, with claim-identifying details, relevant dates, and the issuing provider, facility, shop, or record source visible where applicable. If online upload is not available, support can help arrange fax or mail submission.", "action": "ANSWER_GROUNDED", "next_caller_message": "How many business days does review take?", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 4, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "PROCESS_CASE" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 9, "message": "How many business days does review take?", "reply": "Once the missing files for claim CL-3001 are received, the review usually restarts rather than finishing instantly. The average processing time is usually less than a week, although intake and another review cycle can still be needed before the status is updated. If diagnosis report are incomplete or unclear, the team may ask for more information before reconsidering the denial.", "action": "ANSWER_GROUNDED", "next_caller_message": "That answers my questions.", "observation_before": { "phase": "PROCESS_CASE", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, true, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "PROCESS_CASE", "final_phase": "POST_PROCESS" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 1.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 10, "message": "That answers my questions.", "reply": "Would you like an email summary of our conversation for claim CL-3001, or would you prefer to skip it? It includes what we discussed, the claim status and outcome, and the major follow-up items. Email delivery is simulated in this demo.", "action": "OFFER_EMAIL_SUMMARY", "next_caller_message": "No, skip the email summary.", "observation_before": { "phase": "POST_PROCESS", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "selected", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": true, "action_mask": [ false, false, false, false, false, false, true, false, false ] }, "info": { "task_success": true, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 10.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 5, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "POST_PROCESS", "final_phase": "CONCLUDED" }, "forced_responses": [], "terminal_reply": "I will skip the email summary as requested. Thank you for contacting claims support.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 1.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } } ] }, { "scenario": "ava-no-record-test", "task_success": false, "appropriate_handoff": true, "handoff_request_honored": true, "unresolved_handoff": false, "premature_exit": false, "terminal_consistent": true, "truncated": false, "turns": 5, "return": 1.0, "policy_steps": 5, "policy_choice_steps": 5, "dialogue_response_count": 6, "questions_answered": 0, "distressed_turns": 0, "ignored_distressed_turns": 0, "detector_distressed_turns": 0, "detector_ignored_distressed_turns": 0, "unnecessary_explanations": 0, "forced_scope_responses": 0, "violations": 0, "trajectory": [ { "turn": 1, "message": "My name is Ava Lopez. I need help with my denied dental claim.", "reply": "I\u2019ve kept your claim question for after verification. Please share your date of birth. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My date of birth is 1990-08-21.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "VERIFY_ID" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9951104521751404, "EXPLAIN_VERIFICATION_GATE": 0.004889515228569508, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 2, "message": "My date of birth is 1990-08-21.", "reply": "I\u2019ve kept your claim question for after verification. Please share your phone number. You can also use the verification form.", "action": "ASK_IDENTITY_FIELD", "next_caller_message": "My phone number is +16503882920.", "observation_before": { "phase": "VERIFY_ID", "verified_fields": [ "name", "dob" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": true, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, true, true, false, false, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.25, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "VERIFY_ID", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.9979853630065918, "EXPLAIN_VERIFICATION_GATE": 0.0020146036986261606, "RESOLVE_INTENT": 0.0, "ASK_CLAIM_CLARIFICATION": 0.0, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 3, "message": "My phone number is +16503882920.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 0, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.026224464178085327, "ASK_CLAIM_CLARIFICATION": 0.9737755656242371, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 4, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "My letter says denied dental claim. I have no claim reference or other year to add.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 1, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, false ] }, "info": { "task_success": false, "appropriate_escalation": false, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 0.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "RESOLVE_INTENT" }, "forced_responses": [], "terminal_reply": "", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.026368914172053337, "ASK_CLAIM_CLARIFICATION": 0.9736310839653015, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.0 } } }, { "turn": 5, "message": "My letter says denied dental claim. I have no claim reference or other year to add.", "reply": "I could not match the claim yet. What claim reference, type or year appears on your letter? You can also ask for a human representative.", "action": "ASK_CLAIM_CLARIFICATION", "next_caller_message": "Please connect me with a human representative.", "observation_before": { "phase": "RESOLVE_INTENT", "verified_fields": [ "name", "dob", "phone" ], "memory_slots": { "case_type_hint": "provided", "status_hint": "provided", "date_hint": "", "topic_hint": "provided" }, "data_shield_active": false, "active_case_id": "", "emotion": "neutral", "privacy_concern": false, "refusal": false, "demands_human": false, "resolution_attempts": 2, "grounded_answered": false, "action_mask": [ false, false, false, true, true, false, false, false, true ] }, "info": { "task_success": false, "appropriate_escalation": true, "premature_termination": false, "structural_violations": [], "reward_components": { "turn_cost": -0.1, "new_identity_fields": 0.0, "ignored_distress": 0.0, "unnecessary_gate_explanation": 0.0, "completion": 0.0, "appropriate_handoff": 1.0, "premature_exit": 0.0, "timeout": 0.0, "violations": -0.0 }, "questions_answered": 0, "distressed_turn": false, "empathy_delivered": false, "unnecessary_explanation": false, "phase_before": "RESOLVE_INTENT", "final_phase": "ESCALATED" }, "forced_responses": [], "terminal_reply": "I have recorded a request to connect you with a human claims representative. This demo simulates the handoff; no live transfer takes place. Verification is still required before protected details can be shared.", "selection": { "source": "customer_ppo7", "probabilities": { "ACK_EMOTION": 0.0, "ASK_IDENTITY_FIELD": 0.0, "EXPLAIN_VERIFICATION_GATE": 0.0, "RESOLVE_INTENT": 0.025640306994318962, "ASK_CLAIM_CLARIFICATION": 0.9173513054847717, "ANSWER_GROUNDED": 0.0, "OFFER_EMAIL_SUMMARY": 0.0, "SEND_EMAIL": 0.0, "ESCALATE_HUMAN": 0.05700835585594177 } } } ] } ] } }, "checks": { "customer_ppo42_loaded": true, "customer_ppo42_compatible": true, "customer_ppo42_safety": true, "customer_ppo42_terminal_consistency": true, "customer_ppo42_no_timeouts": true, "customer_ppo42_completion_matches_rule": true, "customer_ppo42_no_unresolved_handoffs": true, "customer_ppo42_distress_matches_rule": true, "customer_ppo7_loaded": true, "customer_ppo7_compatible": true, "customer_ppo7_safety": true, "customer_ppo7_terminal_consistency": true, "customer_ppo7_no_timeouts": true, "customer_ppo7_completion_matches_rule": true, "customer_ppo7_no_unresolved_handoffs": true, "customer_ppo7_distress_matches_rule": true }, "passed": true }