AccountId: 011433970860
ContactId: 3da83453-8865-4fc4-99e7-cfad530163e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301339 ms
Total Talk Time (AGENT): 90878 ms
Total Talk Time (CUSTOMER): 125235 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/3da83453-8865-4fc4-99e7-cfad530163e8_20250108T14:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from a provider's office. We have a patient who has benefits through his employer. The card does not say what the plan is on the front of it. It's a multi-plan, but on the back of the card it says medical claims submission and.
[CUSTOMER][NEUTRAL] Says benefits in a card and it's 90 degree benefits. We have been billing 90 degree benefits for claims and they are denying saying that it's non-covered procedures for office visits, and we're trying to figure out.
[CUSTOMER][NEUTRAL] Are we billing to the wrong address? and these denials are coming from American Public Life Insurance Company. I'm not sure how it got to them being billed to 90 degree benefits, but we're trying to figure out what's going on with this plan.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I, let's see, get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Certainly it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] The employee ID?
[AGENT][NEUTRAL] Um, the policy number on the card?
[CUSTOMER][NEUTRAL] Um, I have an employee. I, I have a group number.
[AGENT][NEUTRAL] Or maybe
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, there's an employee ID number. There is no policy number.
[AGENT][NEUTRAL] OK. What's the ID number?
[CUSTOMER][NEUTRAL] OK, the employee ID number is D as in dog 404-08652.
[AGENT][NEUTRAL] And what's the member's last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you please verify his date of birth.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK, I found him in our system. Um, let me give you his policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That number is 025.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] 2211.
[CUSTOMER][NEUTRAL] OK, and that is under the reference on the denial um EOBs, so that does match up.
[AGENT][NEUTRAL] OK. And.
[CUSTOMER][NEUTRAL] Now should we be using that number instead of the member ID?
[AGENT][NEUTRAL] Yes, ma'am, use that number when you file claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a claim number on the EOB?
[CUSTOMER][NEUTRAL] Um, let's see, yes, it's 353.
[CUSTOMER][NEUTRAL] 6143.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this claim actually denied for the diagnosis code. The diagnosis code is related to alcoholism and under this policy, there's no coverage for um treatment for alcohol or drug abuse. That's why this claim denied.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so, um, hm, interesting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so it is based on the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnosis code shoot.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right, what day did this plan start?
[AGENT][NEUTRAL] OK. One moment and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and I'm showing that it's still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent. [PII], can I get a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is spelled [PII] Last [PII] is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] That is it. I hope you have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye.