AccountId: 011433970860
ContactId: 1b0c4b35-8fb1-41cc-aa5c-8406d82e6ffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309029 ms
Total Talk Time (AGENT): 121235 ms
Total Talk Time (CUSTOMER): 115540 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/1b0c4b35-8fb1-41cc-aa5c-8406d82e6ffa_20250226T17:02_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] Hi, good morning, [PII]. My name is [PII] and I'm trying to get a claim status update, please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] D as in Delta 437311639
[AGENT][NEUTRAL] And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] APL medical. OK, they put the wrong information on here.
[AGENT][POSITIVE] OK, it's right.
[CUSTOMER][NEUTRAL] IMA well it says submit claims to IMA so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not sure what they've got going on.
[CUSTOMER][NEUTRAL] I will
[AGENT][NEUTRAL] Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the ID card, do you see the in-hospital or outpatient policy er number?
[CUSTOMER][NEUTRAL] Yeah, one second please.
[AGENT][NEUTRAL] OK, that's their policy number. May I have that number?
[CUSTOMER][NEUTRAL] Yes, it is 02.
[CUSTOMER][NEUTRAL] 537-820
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, it's gonna be for
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Me [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Um, so you're wanting, you said you're needing claim status or you're wanting to see if a claim has been received?
[CUSTOMER][NEUTRAL] Claim has been received.
[AGENT][NEUTRAL] OK. Hold on one moment.
[AGENT][NEUTRAL] No, I'm not showing any claims have been received yet for her, but it does go to IMA first and they'll do the repricing and then they'll send it over to us to continue and finish out the um claim.
[CUSTOMER][NEUTRAL] OK, so we need to change the ID number from that the number that I started to give you to the policy er number that you pulled it up under that's on the card.
[AGENT][NEUTRAL] Right, that the number is for 90 degree benefits, so we can't use that APL, but the other number is the APL policy number, the 253.
[CUSTOMER][NEUTRAL] OK, so she may have 90 degree benefits with this other policy.
[AGENT][NEUTRAL] 7.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] They, we only have one insurance. It looks like they.
[CUSTOMER][NEUTRAL] Put part of one insurance information in here, but phone number for you guys. So I mean, it's
[AGENT][NEUTRAL] Oh, like they merged everything together.
[CUSTOMER][NEGATIVE] Kind of sketchy what they did.
[CUSTOMER][NEUTRAL] Yeah, they put it all together, but there's only one insurance card in there and that's for ATL, so it's kind of weird.
[AGENT][NEUTRAL] Oh, yeah, OK.
[CUSTOMER][NEUTRAL] Are you showing that she has 90 degree benefits as primary insurance? Can you tell me that?
[AGENT][NEUTRAL] So 90 degree, so 90 degree isn't really like a primary, so like she, this policy has the um multi-plan, the PPO network. So um that's where 90 Degree and multi-plan come in for those additional like wellness benefits.
[AGENT][NEUTRAL] So it's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like they have two policies in one.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] All right. And [PII], is there, oh, I'm sorry.
[AGENT][NEUTRAL] But this would be the only medical 10 no, you're fine.
[CUSTOMER][NEUTRAL] The only medical one is the APL?
[AGENT][NEUTRAL] That we see. Now the member could have more, you know, insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Perfect. I will see if I can get a hold of the patient and see if there's any other insurance or anything because I know usually the policies, the APL policies that I deal with, they're mostly secondary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I have to send primary EOBs, so.
[AGENT][NEUTRAL] Yes, now, if there is other.
[CUSTOMER][NEUTRAL] And like I said, this one was all.
[CUSTOMER][NEUTRAL] Crazy.
[AGENT][NEUTRAL] Now, this is the um, if this is the only insurance thing yeah, we will be primary, but sometimes with the type that they have, there are other, there is other insurance, but we just can't see it on our end if it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, perfect. Thank you for your help. I appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.