AccountId: 011433970860
ContactId: 1559bce9-21f6-48af-89b0-00987f4d1b55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643510 ms
Total Talk Time (AGENT): 202029 ms
Total Talk Time (CUSTOMER): 202060 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/1559bce9-21f6-48af-89b0-00987f4d1b55_20250403T20:42_UTC.wav
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[AGENT][POSITIVE] Good morning. I'm sorry, good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good afternoon, [PII]. This is [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Yes, I'm also doing well. Thank you so much for asking. Um, [PII], I want to check the credentialing, uh, like enrollment status for the group and the individual provider with American Public Life Insurance. Can you please help me with that?
[AGENT][NEUTRAL] You said you wanted to check what with the group? Can you say that again?
[CUSTOMER][NEUTRAL] Prudentialing status like the enrollment status, the group is bar and non bar.
[AGENT][NEUTRAL] You're a provider?
[CUSTOMER][NEUTRAL] Yes, no, I'm calling from provider's office.
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] Right, and you're wanting to know if our group, of the group's credentials?
[CUSTOMER][NEUTRAL] Yes, group and the individual provider as well.
[AGENT][NEUTRAL] What do you mean by that? I'm, I'm asking these questions so I know how to serve you. I don't understand your question though. What the group is the employer that our insurance policies are through? What do you need with the credentialing for the group?
[CUSTOMER][NEUTRAL] I want to check the group is already credentialed with American Public life insurance or not.
[AGENT][NEUTRAL] You, you're wanting me to check if a group is active with us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the group name or the group number? So, not a particular member or patient, you want to know the employer's information.
[CUSTOMER][NEUTRAL] Yes, uh, the group NPI is 1639828569.
[AGENT][NEUTRAL] When you say group, who are you referring to?
[AGENT][NEUTRAL] Are you wanting to know if the providers and network?
[CUSTOMER][NEUTRAL] Like the group practice.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's the, so you're calling for a particular patient and you want to know if your provider is in network for the patient that's coming.
[CUSTOMER][NEUTRAL] With no I'm not checking for the particular patient.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The reason I'm asking these questions is because we're not a, we're not a major insurance, so we don't have our policies don't have networks. The ones that do are through multi-plan. So either way it goes, it wouldn't be APL, but if you don't have a particular member for me to search, I can't really
[AGENT][NEGATIVE] There's nothing for me to go by and this group number is not one of our group or employer numbers. I'm not sure who you're who you're really searching for.
[CUSTOMER][NEUTRAL] OK. OK. Can you please confirm me, do you follow multi-plan, right?
[AGENT][NEUTRAL] Do we follow who?
[CUSTOMER][NEUTRAL] Multi-plan
[AGENT][NEUTRAL] We don't follow multi-plan. Multi-plan provides the PPO network for some of our hospital indemnity policies.
[CUSTOMER][NEUTRAL] OK, sure. Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, mm, just bear with me. I can give you the patient information.
[AGENT][NEUTRAL] OK, I'm here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Patient information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You got this information.
[CUSTOMER][NEUTRAL] OK. OK, sure. Um, hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK. Yes, I have the insurance.
[CUSTOMER][NEUTRAL] Policy number, it's 02598251.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Ensure
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I have [PII].
[CUSTOMER][NEUTRAL] Uh, I don't have date of birth for this number. I have her group number 23433 effective date [PII].
[AGENT][NEUTRAL] OK, wait, wait, wait, wait, go back. Hold on.
[AGENT][NEUTRAL] Hold on. Can you go back to the date of birth and and confirm it, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't have date of birth for this for this number.
[AGENT][NEUTRAL] You don't have the date of birth. What other information demographics do you have for her, for the member?
[CUSTOMER][NEUTRAL] I just have her American Public Life Insurance card. I have the payer ID group number, effective date, and the plan name.
[AGENT][NEUTRAL] OK, um, if you'd like, I can hold if you want to give the member a call and get the date of birth, um, we can verify the last four of the social, we can verify the address, the member's address, um.
[AGENT][NEUTRAL] But we'll have to verify the policy to move forward.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][NEUTRAL] Oh, OK, sure, let me check what information I have on my file. Thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, [PII], I want to check the provider in is in network with this plan, Medlink Group, Med SUP.
[AGENT][NEUTRAL] I understand the purpose of the call. I cannot move forward with the call if we don't verify the insured's policy. Um, do you have any other demographic information for me to verify so that I can provide you with their policy coverage?
[CUSTOMER][NEUTRAL] Yeah is just
[CUSTOMER][NEUTRAL] Sure. Uh, I have the date of birth. It's [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you for verifying and all the information provided is a verification of benefits, not a guarantee of payment. So for the Medlink policy, there is no um network. This is a secondary policy, so we apply to the co-pay, deductible and co-insurance of coverage charges after primary.
[AGENT][NEUTRAL] The primary insurance for this uh policy is Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's policy is that now it's mean we don't need to go in network with this plan.
[AGENT][NEUTRAL] Right, for the secondary insurance, there is no network, but for the primary, there probably is.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, one moment, one moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], if, if the patient have this one plan, a meddling group, uh med SUP, so provider need to in-network with this plan or not, just give me this information.
[AGENT][NEUTRAL] I have already. The answer to your question is this is a secondary insurance, so there is no network, that networks are for primary, we're secondary. So this, I can't, the answer to your question is neither or, we're second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I got it. OK, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, [PII], thank you very much for the information. Can you please, uh, give me the call reference number and your last name initial?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date and um the first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] and [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Got it, [PII], thank you very much for the information. I really appreciate that.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Goodbye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] I