AccountId: 011433970860
ContactId: 3e2f677f-45cd-4dbb-a043-487c2cd79451
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364390 ms
Total Talk Time (AGENT): 108210 ms
Total Talk Time (CUSTOMER): 154759 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/3e2f677f-45cd-4dbb-a043-487c2cd79451_20250110T20:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Uh, yes, I'm trying to get status on a claim that's being denied like why it's being annoyed.
[AGENT][NEUTRAL] OK, and you're calling from a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] Provider's office.
[AGENT][NEUTRAL] OK. May I have your name?
[CUSTOMER][NEUTRAL] Would say
[AGENT][NEUTRAL] Let's see, and Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 00249495803
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, that's a lot of numbers.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] Yeah, that's, that's a lot of numbers to be one of our policy numbers. Um, our policy number starts with a 0 followed by 7 digits only. Do you have the copy of the card, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02494958
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. All right, Ms. [PII], this particular policy is um is managed by Web TPA. So all the claims, benefits, eligibility, all that goes to web TPA.
[CUSTOMER][NEGATIVE] I just tried calling them they couldn't find them.
[AGENT][NEUTRAL] Did you give them the number?
[CUSTOMER][NEUTRAL] He told me to call you and this is this is the number on the back of the card to call for claim status.
[AGENT][NEUTRAL] OK, I'll have to get them.
[CUSTOMER][NEUTRAL] I just keep getting the run around everywhere I call.
[AGENT][NEUTRAL] I do apologize. I'll have to get them on the line and I'll have to give them the policy number because yeah, it is managed by them, OK? So give me just a second, let me get somebody on the line for us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[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 emergency, 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 [PII]. For information and phone numbers for the Beach Street PPO network, please press [PII].
[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 [PII] now or simply stay on the line.
[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]. Can I please have the member ID?
[AGENT][NEUTRAL] Hi, Ms. [PII]. This is [PII] with APL. I'm trying to transfer a provider that said that she was told to call us, but it is, the claim is supposed to be with um with TPA. The policy number she gave me in the beginning was incorrect, so let me give you this one. Maybe you can find her with this one. the policy number is 02494958.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And may I have your name one more time please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, first and last name and date of birth of the patient.
[AGENT][NEUTRAL] OK, let me go back to this one moment.
[AGENT][NEUTRAL] OK, so he's, she's looking for [PII].
[AGENT][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] And you said she's calling for claims?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, if you wanna transfer to me I can take it from here.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. Let me put her in.
[AGENT][POSITIVE] Thank you for holding and being patient for you Miss [PII]. I got Miss [PII] on the line. She's gonna assist you with the claim.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You work.
[CUSTOMER][NEUTRAL] Hi ma'am, my name is [PII]. I'm a customer service. Um, may I please have your name?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, and may I have the name of the office?
[CUSTOMER][NEUTRAL] Pediatric Health Care Alliance.
[CUSTOMER][NEUTRAL] Alright, give me just a moment. Let me fill in a few things here on my side, and then I can get the claims pulled up for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I have a good callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].