AccountId: 011433970860
ContactId: 09fc8dc5-1554-4d32-ba9d-5cff9f393b5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390440 ms
Total Talk Time (AGENT): 172595 ms
Total Talk Time (CUSTOMER): 170022 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/09fc8dc5-1554-4d32-ba9d-5cff9f393b5f_20250310T15:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII] and I was just trying to see if the patient actually has coverage with you all.
[AGENT][NEUTRAL] OK, [PII], you're just needing to verify eligibility for a member, is that correct? Yes, ma'am, I can help you with that. And what is your callback number?
[CUSTOMER][POSITIVE] Yes mhm yes ma'am.
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 017.
[CUSTOMER][NEUTRAL] 92105.
[AGENT][POSITIVE] OK, thank you. Give me just a couple of moments please to get the member's information pulled up. Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Perfect, mhm.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is. Last name is [PII], uh first name is um [PII]. It's [PII]
[AGENT][NEUTRAL] OK. And date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber April on the supplemental policy and it is active. What's an effective date of [PII], and April, just a couple of additional things. If you all will be filing a claim with us for her, we will also need for you to include the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Sure. Mhm.
[AGENT][NEUTRAL] If you do have to have that. And then once we've processed our claim, we do have a portal that you should be able to check our claim status in and have access to our EOB and that website is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see if I can go to that.
[AGENT][NEUTRAL] And again that's gonna be once the claim has been processed.
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] But she would just set up
[CUSTOMER][NEUTRAL] You said secured [PII]?
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, I've tried actually um uh logging on and I have not gotten um access to this yet.
[AGENT][NEUTRAL] OK, so it's a self registering portal but again if there's not a claim on file for the member, it's not going to find anything.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. OK, OK.
[AGENT][NEUTRAL] Because you can't check eligibility, that's only for claim status, so we would have to have received the claim and processed it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I would use that claim number to be able to um.
[CUSTOMER][NEUTRAL] Verify or to be able to um create an account with you all or do I just need the patient member ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, now, it doesn't ask for the patient's member ID it asks for the patient account number and that is the provider's patient account number, the one you all submit on your claim form and box.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Is it 26?
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Cause it does say provider's patient account number. It's not their APL policy number.
[CUSTOMER][NEUTRAL] Oh, OK, 26. OK, so it would be the PLA so it would be our account number.
[AGENT][POSITIVE] That is correct, and I believe it, mhm, and I think it does state that on there.
[CUSTOMER][NEUTRAL] In box 26.
[AGENT][NEUTRAL] That it's the provider's patient account number, not their policy number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe. I believe it does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so the account because it does say patient account number so I didn't know if it was the patient member ID that's with you guys or if it's our account number.
[AGENT][NEUTRAL] Yeah, let me just pull that up because I know they've made some adjustments on the, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I just wanna look at one thing. Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Pa account can be found at the following locations [PII].
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it does say [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, so that's, yes, that is the provider's patient account number.
[CUSTOMER][NEUTRAL] That does show box 23.
[CUSTOMER][NEUTRAL] Like what it's got like different oh that's an ADA form so yeah it would be 26. OK, so once this claim would process um do you guys, I was trying to see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I think I have a fax number for you guys because I do have the EOB ready to send off but I didn't know it's showing that we had it listed in our national elevator so I need to update the claim before I can actually submit it to you guys because they have it down as American Public Life um is your fax um number gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], is that still a good fax for you all? OK, alright.
[AGENT][NEUTRAL] Mhm, it is, it is, uh-huh, and just put attention claims.
[CUSTOMER][NEUTRAL] OK perfect alright I'll get this updated on our end and then I will submit that claim over via fax and then uh get that taken care of. Alright [PII], and do you have a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] you will use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] you have a wonderful day.
[AGENT][POSITIVE] OK. Well, I hope you do too, [PII] if that's all then that I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.