AccountId: 011433970860
ContactId: 61d62c93-ddb0-4a72-9352-25474469eae0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387339 ms
Total Talk Time (AGENT): 178412 ms
Total Talk Time (CUSTOMER): 127912 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/61d62c93-ddb0-4a72-9352-25474469eae0_20250515T14:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] connecting from providers office to check on a claim status. Could I help with that?
[AGENT][NEUTRAL] Yes, I can check on the account for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII] Last name initial is [PII]. And can you repeat me your name also?
[AGENT][NEUTRAL] Yes, it's, uh, [PII]
[AGENT][NEUTRAL] And then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes. It's D as in Delta 43,302,090.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers. That is through, uh, they're called 90 degree benefits. I can give you their information and transfer you to them, or if you have the member's social, I could try to see if they have a policy with us.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh, but the previous call was made on this, uh, number.
[CUSTOMER][NEUTRAL] ID
[AGENT][NEUTRAL] That's not a member ID through APL. That's a different policy number. That policy number is through um 90 degree benefits, not American Public Life. I have no way to search with that policy number.
[CUSTOMER][NEUTRAL] I have called the friends also. I will check.
[AGENT][NEUTRAL] I can transfer you to them or if you have the member's social I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] Uh, I have one more ID, so can you check with that, uh, on once?
[AGENT][POSITIVE] Yeah, we can try that.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] What was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's uh [PII] and date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. Yes, that is our policy number for them. Um, what was the date of service for this clientele?
[CUSTOMER][NEUTRAL] It's uh [PII]. Total charges is $900 even.
[AGENT][NEUTRAL] 900. OK. One moment, please.
[CUSTOMER][NEUTRAL] Yeah, and I have a specific question only.
[CUSTOMER][NEUTRAL] Oh no, I just need the gender claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you just needed the the status correct?
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK. So for this kind, [PII], it is stating, uh, this is for anesthesia. So the way that this policy works is we have to have uh the surgical charges for this state of service so that we can do both. We can't do just the anesthesia as the anesthesia benefit pays a percentage based off of the surgery benefit.
[AGENT][NEUTRAL] So we have to have that surgery benefit.
[CUSTOMER][NEUTRAL] So we we have um this number have the surgery benefit of uh for the date of service, right?
[AGENT][NEUTRAL] I have not received anything for the surgery for this state of service, just the anesthesia. So we can't pay the anesthesia on its own. We have to have the surgical uh charges as well. And I'm not showing that we've received that information.
[CUSTOMER][NEUTRAL] Means uh member plan uh does not cover the surgery's benefit, right?
[AGENT][NEUTRAL] No, it does cover it. Um, we need this, we don't have any of the surgical information, just the anesthesia. So we need both. We need the surgical benefit before we're able to pay the anesthesia benefit.
[CUSTOMER][NEUTRAL] Yeah, I got it. So my question is that uh member's plan does not cover the benefits for the date of service, right?
[AGENT][NEUTRAL] It is covered, but not on its own. We need the surgical benefit as well. We just have the information for anesthesia. Anesthesia is covered under this policy, but we have to have the surgical information as well.
[CUSTOMER][NEUTRAL] OK, got it. And uh can you please check the hospital claim status?
[CUSTOMER][NEUTRAL] For the same date of service?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] What was that? I'm sorry?
[CUSTOMER][NEUTRAL] Can you please check the hospital claim status for the same date of service?
[AGENT][NEUTRAL] I only have the, the only claim I have for this state of service is the anesthesia. I have no other information for this state of service, no other claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with this member's benefit plan is HMRPPO?
[AGENT][NEUTRAL] Uh, it's neither. This is a limited indemnity medical plan.
[CUSTOMER][NEGATIVE] And limited in the community.
[CUSTOMER][NEUTRAL] OK. Can you uh confirm me the claim number?
[AGENT][NEUTRAL] Yes, that is 3561909.
[CUSTOMER][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] 909
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, I have a different claim number on my file. It's 356.
[AGENT][NEUTRAL] We have received, we have received it, yes, I have another one that ends in 913, uh, that is the same one though.
[CUSTOMER][NEUTRAL] OK, sure. And uh
[AGENT][NEUTRAL] So the original claim number was the one ending in 909.
[CUSTOMER][NEUTRAL] OK, sure. And can you help me the the process the date for this claim.
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, this claim processed, uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yea[PII], I'm done with my questions. So can you give me the reference number?
[AGENT][NEUTRAL] That would be my first name, last initial, and today's date. Uh, so my last initial is [PII], was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] No, I'm done with my questions. Thank you for your help. Have a nice day. Bye bye. Take care.
[AGENT][POSITIVE] Alright, thanks for calling APL you too bye.
[CUSTOMER][NEUTRAL] Yeah.