AccountId: 011433970860
ContactId: 41a4faa6-8b62-4184-8845-db48059e6e8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362950 ms
Total Talk Time (AGENT): 115263 ms
Total Talk Time (CUSTOMER): 219409 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/41a4faa6-8b62-4184-8845-db48059e6e8b_20250205T20:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I need to find out, um, I've got this, this is [PII] with Lex and Family Medicine, and I have a patient that we've received a letter, um, from the claims department I guess with you guys and stating that y'all that the number was incorrect, the ID number, so I'm trying to figure out which one is the ID number because the one on the card it says medical ID number, but then there's also policy certification number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The Policy certification number is the policy number.
[CUSTOMER][NEUTRAL] OK, so that is the one that we use for uh when we need to file a claim?
[AGENT][NEUTRAL] I'm, I'm sure, yes, that is correct, but I'm not sure what the letter says. Could I have a policy number, [PII]?
[CUSTOMER][NEUTRAL] Oh, I hope so. Let me see, uh, 02217767.
[AGENT][NEUTRAL] I have a callback number for you and that policy number.
[CUSTOMER][NEUTRAL] Uh, callback number is [PII] and your policy number again?
[AGENT][NEUTRAL] No, the member's name and date of birth.
[CUSTOMER][NEUTRAL] Name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said that we sent you out a letter?
[CUSTOMER][NEUTRAL] Yes, we received it today. It says um the enclosed information was submitted to APL.
[CUSTOMER][NEGATIVE] However, we're unable to locate the current policy with the information provided.
[CUSTOMER][NEUTRAL] And then they were asking for the information they sent a copy of the health insurance claim form that we sent um to get paid and I'm looking at the insurer's ID number up in the top.
[CUSTOMER][NEUTRAL] Um, do you see where that correspondence was, uh, sent out to us?
[AGENT][NEUTRAL] Mm, no, ma'am, but the correct policy number is the number that you gave me. What number did you guys utilize when you submitted the claim and where did you send the claim to because the claim is this is a third party administrative claim.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Right, the claim went to uh [PII].
[AGENT][NEUTRAL] This, this IMA.
[CUSTOMER][NEUTRAL] Right, is that where it's because it says submit claims to that's what it says on the back of the patient's card.
[AGENT][NEUTRAL] Right, which is IMA.
[CUSTOMER][NEUTRAL] So that's the address that, is that correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] His IMA mhm uh what did you wanna get? I'm sorry.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You gave me his name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII], and the number that we put for the insurance number was the medical ID number which starts with a [PII].
[AGENT][NEUTRAL] No, it's the [PII] number.
[CUSTOMER][NEUTRAL] OK, alright, so that's the one that should be filed, but did we send it to the correct address?
[AGENT][NEGATIVE] You did. You sent it to the correct place, but it just was the incorrect.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or to.
[AGENT][NEGATIVE] Incorrect um policy number.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So let me ask you if because the letter states that um see if I understand how we're unable to this information.
[AGENT][NEUTRAL] Locate the member.
[CUSTOMER][NEUTRAL] Yes I was looking for is the enclosed.
[CUSTOMER][NEUTRAL] Information was submitted to APL. however, we were unable to locate the correct policy with the information provided, but on the information you asked me for, uh, say again, I'm sorry.
[AGENT][NEUTRAL] What is the date of
[AGENT][NEUTRAL] What's the date of service for the claim?
[CUSTOMER][NEUTRAL] The data service is [PII].
[AGENT][NEUTRAL] Make sure we don't have it on file. So the policy number that you provided me with is the correct policy number the 221-77667.
[AGENT][NEUTRAL] That's the policy number you should use.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, alright, so we'll just refile it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, because we don't have a claim on file. We don't have it here at American Public Life because you submitted to the IMA.
[CUSTOMER][NEUTRAL] Right, so, but it's supposed to go to I.
[AGENT][NEUTRAL] And it's IMA is a third party. Yeah, it's supposed to go to IMA and once IMA verify if it's something that they can pay, they're gonna send it here to American Public Life for us to process it. However,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Someone can locate the member in the system because of the ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, so we just need to change that.
[AGENT][NEUTRAL] But if it came here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, if you came here though, we would have been able to find him by the name, so I don't, I don't know.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] The name and the uh the date of birth, cause just like you found it with me, so, mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, you gave me a policy number. That's how I found the member.
[CUSTOMER][POSITIVE] Oh, did, oh yeah, I did sorry.
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] All right, well, I guess I'll just have to uh resubmit it then.
[AGENT][NEUTRAL] Resubmit the claim, yes ma'am, you will have to resubmit the claim so that we can process it.
[CUSTOMER][POSITIVE] OK. All right. No problem. Thank you so much for your help.
[AGENT][NEUTRAL] Is there anything else that I can assist you with, [PII]?
[CUSTOMER][POSITIVE] Um, no, you've been most helpful.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks, good bye.