AccountId: 011433970860
ContactId: 1f650fb1-79f4-47aa-ac71-95baee99c3b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479369 ms
Total Talk Time (AGENT): 199150 ms
Total Talk Time (CUSTOMER): 162929 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/1f650fb1-79f4-47aa-ac71-95baee99c3b6_20250529T13:16_UTC.wav
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[AGENT][POSITIVE] Good Morning, thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] calling from provider's office, and I'm checking on eligibility status for one of our patients.
[AGENT][NEUTRAL] OK, [PII], you need to check eligibility only for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number.
[CUSTOMER][NEUTRAL] Moment.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Member ID I have is.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 610069448.
[AGENT][NEUTRAL] OK, thank you, but [PII], is that, um, that is not an APL policy number. Are you looking at their ID card that says APL?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's American Public Life, right?
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] And you have a, are you looking at the ID card?
[CUSTOMER][NEUTRAL] Mm, I do have the group number. Yes, I'm looking at the ID card. I have the group number with me.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] What is the patient's name?
[CUSTOMER][NEUTRAL] Group number.
[AGENT][NEUTRAL] No, not the group number.
[CUSTOMER][NEUTRAL] Yeah, the patients, uh,
[CUSTOMER][NEUTRAL] Patient's last name is uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] The first name is what?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. All right, so on the ID card that you're looking at, that 61 number, what does it say out beside that number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Give me one moment. Um, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's employee and spouse coverage date plan is uh meddling select group.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so on that, it should say there should be an in-hospital or an outpatient number.
[CUSTOMER][NEUTRAL] Yeah, I have, I have in hospitals cert number, certification number, outpatient benefit certification number.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, ma'am. So I need those numbers. What is that first number that you gave me?
[CUSTOMER][NEUTRAL] That is uh the member ID I have given you.
[AGENT][NEUTRAL] OK, I need to, OK.
[CUSTOMER][NEUTRAL] OK. Uh, can I go ahead with in pay in hospitals?
[AGENT][NEUTRAL] And that member ID is, are you?
[AGENT][NEUTRAL] Yes, [PII], I wanna, I'm trying to get some understanding that member ID is that on the member's ID card also? That's 610, or is that something they just wrote in? Let me look at that ID card then so I can see exactly what the ID card looks like. Just one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me the inhospital or outpatient number first so I can pull up the ID card.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 36
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 972-4 ML 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That's all.
[AGENT][NEUTRAL] OK, so I'm looking at our ID cards.
[AGENT][NEUTRAL] And that 610 number is not on our ID cards.
[CUSTOMER][NEUTRAL] Mm, give me one moment. Let me just crosscheck.
[AGENT][NEGATIVE] Not for American public life, it's not. Mhm.
[CUSTOMER][NEUTRAL] So are you not, are you not finding patients with the, with the name?
[AGENT][NEUTRAL] Yes, I am. Yes, ma'am.
[AGENT][NEUTRAL] I'm locating it with that policy number that you just gave me, so the poli any information provided.
[CUSTOMER][NEUTRAL] So can you please provide me with, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Will be a verification of benefits and not a guarantee of payment and what is her date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So the policy number you gave me is an old policy number that's no longer active. That policy actually termed 81 of 2024 and she has a different policy number that is active.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the currently active policy is 02518171.
[AGENT][NEUTRAL] And it has an effective date of [PII]?
[CUSTOMER][NEUTRAL] And the policy is still active?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] And this is a supplemental plan, right?
[AGENT][NEUTRAL] It is, yes, ma'am.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] And when the claim is submitted, if you all do file a claim with APL for her, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, we'll, we'll send that to you. And before that, may I get your name?
[AGENT][NEUTRAL] Again, my name is [PII] and you would use my name along with today's date as your call reference number and to check claim status for our members [PII].
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] One second month.
[AGENT][NEUTRAL] We have a portal that you all can use for claim status by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Let me just confirm the address like where we need to send these medical claims to.
[AGENT][NEUTRAL] OK, go ahead with what you have.
[CUSTOMER][NEUTRAL] Uh, it's [PII], it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Mhm. One second.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] one day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And thank you so much for your assistance. And before we end our call, any reference number for this call?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Yeah, thank you so much bye.
[AGENT][POSITIVE] OK, you're welcome and if that's all I can help you with, thank you again for calling APL and I hope you have a nice day.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] All right, [PII], bye-bye.