AccountId: 011433970860
ContactId: 529af62d-13ce-48c2-a63f-c105aa3f8b78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722599 ms
Total Talk Time (AGENT): 308358 ms
Total Talk Time (CUSTOMER): 243248 ms
Interruptions: 12
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/529af62d-13ce-48c2-a63f-c105aa3f8b78_20250224T18:25_UTC.wav
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[AGENT][POSITIVE] Good Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. Here is [PII] calling from AmeriClinic provider facility office.
[AGENT][POSITIVE] Yes, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] With the claim status, just one claim.
[AGENT][NEUTRAL] OK, you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] OK, [PII]. And what is the next number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] are the last four numbers, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you and the patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Sure. It is D as in David, 46401412.
[AGENT][NEUTRAL] What is the number again?
[CUSTOMER][NEUTRAL] D. 46401412.
[AGENT][NEUTRAL] OK, now [PII], that is not a policy number for American Public Life. That is a 90 degree benefit number. Does the patient also have a policy with APL or were you trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. I don't have a policy number.
[AGENT][NEUTRAL] OK, do you know if the member what company were you trying to reach?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can you search the member by his name and date of birth?
[AGENT][NEUTRAL] OK, so first off, yeah, I can try, but what company were you actually trying to call?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 90 degree benefits.
[AGENT][NEUTRAL] OK, so you are not speaking with 90 degree benefits. You are speaking with American Public Life. Did you call [PII]?
[CUSTOMER][NEUTRAL] your time.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you just needed to have selected option one.
[CUSTOMER][NEUTRAL] options
[AGENT][NEUTRAL] I'll be happy to try and connect you. And again, you said that number was D46401412. Is that correct?
[CUSTOMER][POSITIVE] I'm happy to try.
[CUSTOMER][NEUTRAL] And if you have that number with me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Is there anything else, [PII] that I can help you with before I transfer you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree. All agents are currently assisting other callers. Please remain on the line and your call will be answered by the next agent.
[CUSTOMER][POSITIVE] We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience.
[CUSTOMER][POSITIVE] Please remain on the line, and we will be with you shortly.
[CUSTOMER][NEUTRAL] 90 Degree Benefits. This is [PII]. How can I help you?
[AGENT][POSITIVE] I like to try again.
[CUSTOMER][NEUTRAL] Hey, long time no talk to.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so I don't have this or this member's name, but the lady on the line, her name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the phone number she gave me, is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the number she gave me is [PII].
[AGENT][NEUTRAL] [PII] and she said she was trying to reach.
[CUSTOMER][NEUTRAL] [PII]. I just talked to her.
[AGENT][NEUTRAL] She said she was trying to reach 90 degree benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, she reached us and I didn't have the claim she's looking for and they also have a plan with y'all so I thought maybe it went to y'all. Well, when I told her we processed the they have the Mac in hand, so I told her we process the preventative and office visit claims so then she asked me to transfer her to who processes the medical claims, so I did so.
[AGENT][NEUTRAL] OK, she didn't.
[AGENT][NEGATIVE] Oh Lord, there's such a barrier in communication with the some of these individuals.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] OK. What's the person's name? What's the person's name?
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII] Let me see if I can.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, when she said she was trying to reach 90 degree benefits, I didn't even try to.
[AGENT][NEUTRAL] Search the name. She did not tell me that she, she didn't.
[CUSTOMER][NEUTRAL] Yeah, she'd already talked to us.
[AGENT][NEUTRAL] She did not mention that.
[CUSTOMER][NEUTRAL] Of course not.
[AGENT][NEUTRAL] Well he doesn't have a change [PII].
[AGENT][POSITIVE] Thank you, [PII] for waiting before I get back on the line with her to see.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] To locate him.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so I'll just, I'll, that's fine. I'll just get back on because I know I'm not gonna hold you up. I'll get back on the line with her and help her.
[CUSTOMER][NEUTRAL] OK. Did you find the, the member?
[AGENT][POSITIVE] Uh, yes, I did. Yeah. I did. So thank you, ma'am. OK.
[CUSTOMER][NEUTRAL] OK. All right. All right, ma'am.
[CUSTOMER][POSITIVE] You're welcome. All right. Bye.
[AGENT][NEUTRAL] Bye. All right, bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK, [PII], this is, hello, [PII], are you still there?
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Hi, so this is still [PII] with APL. When I was going to transfer you, they said that you had already spoken to them and they had to contact APL.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I'm sorry, you had not said, you did not tell me that you had already spoken to 90 Degree benefits or I would not have tried to transfer you back.
[CUSTOMER][NEUTRAL] So I'm not.
[CUSTOMER][NEUTRAL] OK, then what should I do then?
[AGENT][NEUTRAL] So any information that I provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Patient is [PII].
[AGENT][NEUTRAL] What is the last name?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service, [PII]. Total charge $152 with 25 cents. 152.25.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So the correct policy number that you should have for his coverage with APL is 252.
[AGENT][NEUTRAL] 0589.
[AGENT][NEUTRAL] And this policy is active.
[CUSTOMER][NEUTRAL] Ma.
[AGENT][NEUTRAL] The effective date on this plan is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me one moment to see if we receive this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no claim on file for data service [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, did you check the medical claims?
[AGENT][NEUTRAL] Yes, ma'am, there is no claim on file for date of service [PII].
[CUSTOMER][NEUTRAL] OK. Can you wait? OK, sure.
[CUSTOMER][NEUTRAL] Sure, can you verify for the mailing address?
[AGENT][NEUTRAL] Yes, ma'am. Go ahead with what you have and I can confirm if that's correct.
[CUSTOMER][NEUTRAL] Sure. I have 19 the benefits INC [PII]. OK. Tell me the correct one.
[AGENT][NEGATIVE] No, ma'am. That is not correct.
[AGENT][NEUTRAL] For this for this claim, you should submit it to IMA.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Egan
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. What's the timely filing limit for the initial submission?
[AGENT][NEUTRAL] There is, yes ma'am, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once the claim has been processed, excuse me, once the claim has been processed, we do have a portal in which you should be able to check claim status and also have access to the explanation of benefits, and that website for our portal, Adela is secured.
[CUSTOMER][POSITIVE] Thank you very much. May I have your name with last?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, sir.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it's for the reference number, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's your name, please?
[AGENT][NEUTRAL] Again, my name is [PII]
[CUSTOMER][POSITIVE] OK, thank you. Thank you very much. Have a good day.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am. And if that is all I can help you with, Adela, thank you for calling APL and I hope you have a nice afternoon also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure. Thank you very much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Right.