AccountId: 011433970860
ContactId: 2875b23b-7afe-4d58-9430-81fe1e6a2f3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418119 ms
Total Talk Time (AGENT): 214808 ms
Total Talk Time (CUSTOMER): 180848 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/2875b23b-7afe-4d58-9430-81fe1e6a2f3c_20250509T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the initial of your last name for my note, [PII]?
[AGENT][NEUTRAL] That's A
[CUSTOMER][NEUTRAL] Thank you. I'm calling from the provider's office to verify eligibility on a member. Is this a medical insurance?
[AGENT][NEUTRAL] Yeah, I could take the eligibility.
[AGENT][NEUTRAL] We do offer uh different kinds of policies so I can get that pulled up and let you know what the member has um what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII], last initial [PII]
[AGENT][POSITIVE] Thank you and then [PII], before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII] is my direct line.
[AGENT][NEUTRAL] OK, thank you and then do you have a policy number?
[CUSTOMER][NEUTRAL] I do. It starts with the letter D for David, 45401583.
[AGENT][NEUTRAL] OK, so [PII], that's actually not one of our policy numbers that is through, uh, they're called 90 Degree benefits. Um, I can get you their information and transfer you to them, uh, or if you have the member's social, I can see if they have any policies with us.
[CUSTOMER][NEUTRAL] All right. You know what, it's very strange. I didn't think this was the policy number because I'm looking at a letter we got and it has a different policy number on it.
[AGENT][POSITIVE] Oh, we can try that.
[CUSTOMER][NEUTRAL] Alright, 02587329.
[AGENT][NEUTRAL] That sounds more like us. One moment.
[AGENT][NEUTRAL] What was the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] It, the name on this policy is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so yes, this is um a limited indemnity medical plan that they have with us. It is currently active. That effective date was [PII] and then so that confusion comes this is part of a multi plan so again that policy number you gave me, it's very likely they do have other policies through different carriers, but this is, this is one that they have with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] All right, so this is a limited indemnity now but I'm looking at a letter we got, uh, hold on, it's split in half on our system and it said something about.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, records indicate that premium was not received, therefore benefits are not payable. If premium is being paid through COBR, then contact us and that's when I called that number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, um, do you have that claim number, [PII]?
[CUSTOMER][NEUTRAL] The claim number that I'm looking at, let me see if, oh yeah, 3583309.
[AGENT][NEUTRAL] OK, one moment, let me take a look.
[CUSTOMER][NEUTRAL] I think there were 2 claims out here. Yeah, there are. Let me just see what, if there's another claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that claim this one was just processed uh [PII] and what that means is that of course we're still waiting for information from their employer to verify their eligibility for this claim. So once we get that response we'll be able to complete this claim being processed so it's not an actual denial as much as it is just kind of pending information.
[CUSTOMER][NEUTRAL] All right, now you
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Now, you also said something about 90 degree benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that is a different, I'm not from what I understand, I think that policy that they might have through them is more along the lines of wellness, um, and preventative things like that, but I can absolutely get you their information if you wanted more information regarding that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. And I also have another claim number for another data service on this member from your, you know, from American Public Life, if you can check it.
[AGENT][NEUTRAL] Is that the one is it ending in 9782?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, these are the only claims we have on file for this number. Uh, give me just a moment, let me take a look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, now this one, we were unable to pay a benefit as per this policy, anesthesia is not covered.
[CUSTOMER][NEUTRAL] Oh, so both of these are for anesthesia, so both of them wouldn't be covered.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] All right. So they're not covered. Maybe I should call that other 90 degree you said, 90 degree benefits.
[AGENT][NEUTRAL] It's worth a shot to see, especially since you have that policy number through them, um, and it very well might have been the phone number that you dialed that got you to us, [PII], as their prompts are a little bit confusing. Um, did you dial the number that was uh ending in [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I dialed [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, yeah, that is our number. OK, so I'll go ahead and give you uh their 90 degrees phone number, um, whenever you're ready, and then I can transfer you to them as well if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, you don't give a reference number or anything for your call. I'm just gonna note that that anesthesia is not covered under that plan. Mhm. OK, I'll take that. Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, I can, I can give you a reference number.
[AGENT][NEUTRAL] I can give you a reference number that is um.
[AGENT][NEUTRAL] It'd be my first name, last initial, and today's date. Uh so my name is spelled [PII] And then if you needed uh something, I can send you this EOB, Barbara that shows that does state that anesthesia is not covered.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it says non-covered procedure on here and I think that's enough for us. And I'm gonna verify it with you uh, you know, on the phone call that it's not covered. So now if I have that other number, I'll call them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure. OK.
[AGENT][NEUTRAL] OK, yes, are you ready for that now?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then if you were to dial that number to speak with 90 Degree, you would select option 1.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for your help. Have a great weekend.
[AGENT][NEUTRAL] Of course, did you want me to go ahead and transfer you?
[CUSTOMER][NEUTRAL] Um, you know what? No, I think I have to do one more thing before I call them, so as long as I have the number, I can give them a call. Thank you again.
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] Sounds good thank you have a great weekend, [PII].
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thanks bye bye.