AccountId: 011433970860
ContactId: 170da9a1-db01-471e-b525-2189ce2837be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 554390 ms
Total Talk Time (AGENT): 196043 ms
Total Talk Time (CUSTOMER): 277828 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/170da9a1-db01-471e-b525-2189ce2837be_20250127T16:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um,
[CUSTOMER][NEGATIVE] I don't know if I've even reached the correct department. I went to my um yearly exam with my um OB and used my insurance for the first time and a few weeks later I got a bill in the mail for $220 so I'm not sure what happened, what's going on with that, um, or even if I should have called them, their billing department or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I can take a look at everything and see what's going on in the coverage and if I can determine why you received the bill. Um, but may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's hyphenated.
[AGENT][NEUTRAL] All right, and [PII], may I have your policy number and then a good contact number?
[CUSTOMER][NEUTRAL] OK, uh, the policy number, where do I find it because I'm on my husband's work insurance.
[AGENT][NEUTRAL] OK. Um, do you have the ID card?
[CUSTOMER][NEUTRAL] Uh is it the member number?
[CUSTOMER][NEUTRAL] Uh, yes, I, I believe so. American Public Life.
[AGENT][NEUTRAL] Yes, ma'am. So it should say in hospital or outpatient policy er number.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It should start with a 01 or 02.
[CUSTOMER][NEUTRAL] OK, it, it just says member number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] 6699.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Alright, and I just need you to verify your um date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] My date of birth is
[CUSTOMER][NEUTRAL] [PII] and the address is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So hold on one moment, let me see if I can.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so there's two things. So,
[AGENT][NEUTRAL] For your policy, the claims are processed through web TPA.
[AGENT][NEUTRAL] I can give you their phone number and, and, you know, transfer you over, get you a representative, but APL does not process the claims for your um policy. But web CPA can definitely, once we give them, um, you won't have to verify anything with them, but once you give them like the data service which you're looking for, they'll be able to let you know if a claim has been received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what's the name of the?
[AGENT][NEUTRAL] The company is Webb TPA.
[CUSTOMER][NEUTRAL] P as in Paul.
[AGENT][NEUTRAL] Um, so Webb, T as in Tom, P as in Paul, and then A like apple.
[CUSTOMER][NEUTRAL] Or T as in Tom.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that phone number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the data of service of uh when you went to the OB?
[CUSTOMER][NEUTRAL] Yes, um, my, the date of service was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just in case they ask me, I'm gonna tell them.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you received a bill for $220 after the claim was processed and you submitted your ID card to them.
[AGENT][NEUTRAL] I just wanna make sure I have it so I can explain it right. OK, good. Um, Ms. [PII], do you mind if I place you on just a brief hold? I'm just gonna call on the other line.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] All right, and before I do that, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, ma'am.
[AGENT][POSITIVE] Alrighty, well, thank you for calling AP.
[CUSTOMER][NEUTRAL] Um, I'm sorry, I'm sorry. I'm sorry, yes. Um, how do I go about, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Checking to see what doctors are within the network as far as the insurance that I have because
[CUSTOMER][NEGATIVE] I really don't wanna have to deal with this anymore because if I have to come out of pocket and pay this 220, I'm just gonna be so frustrated.
[AGENT][NEUTRAL] Well, you don't have, so for your policy, there's no like network. It's not like a PPO or HMO. This is, we don't offer major medical insurance. So this um this policy doesn't have a network, you can virtually you can go wherever you like. Usually they will call us before the services are done to see like what the coverage is, um, so I'm sorry they didn't do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] All right. And was there anything else before I get the representative for you?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. That was it.
[AGENT][NEUTRAL] You sure? OK. Well, hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome and thanks for calling APL. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] Whoa, how did I do that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an eme[PII], please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account such as an address change, add or drop a dependent, or wish to modify your coverage in any way, please call American Public Life at [PII]. If you are a physician or hospital calling to verify medical eligibility, please press 1. For information and phone numbers for the Beach Street PPO network, please press 2.
[CUSTOMER][NEUTRAL] For questions concerning pharmacy services, you may contact Caremark at [PII]. To speak to a customer service representative regarding any other issues, please press 3 now or simply stay on the line and someone will assist you. Thank you.
[CUSTOMER][NEUTRAL] Due to severe winter weather, you may experience longer wait times. As this is not an urgent matter, please call back at a later date. Thank you for your patience.
[CUSTOMER][NEUTRAL] Please note, your call may be monitored or recorded for quality assurance. The information provided during this call is only a description of benefits and is not a guarantee of payment. Benefits are based upon eligibility at the time services are rendered and all plan provisions.
[CUSTOMER][POSITIVE] Thank you for calling customer service. My name is [PII]. How may we assist you today?
[AGENT][NEUTRAL] Hey, [PII], my name is [PII]. I'm calling from APL. I have an insured on the other line who needs to go over a claim status. Well, she's trying to see if there is a claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sure and then [PII] what's the member ID?
[AGENT][NEUTRAL] Um, I have 02506699.
[CUSTOMER][NEUTRAL] OK and then is the claim on which who's the claim on?
[AGENT][NEUTRAL] Um, it's for [PII], and the date of service is [PII].
[CUSTOMER][NEUTRAL] OK, I have her [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And her birthday was.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh yeah, I didn't know you're already in there. Thank you, [PII], can I get your area code and phone number please in case we get cut off?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, let me, uh, and then, uh, your insurance company gave me the data service of 1112 [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, I'll go check it for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I and [PII], am I OK to end the line? Are you guys OK?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Oh, [PII], you go ahead and, and I know you're busy just we're good, OK, thank you for your help, [PII].
[AGENT][POSITIVE] All right. You're welcome. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.