AccountId: 011433970860
ContactId: 65ebea14-75b0-4423-9b25-877239007d43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1553400 ms
Total Talk Time (AGENT): 217065 ms
Total Talk Time (CUSTOMER): 566174 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/65ebea14-75b0-4423-9b25-877239007d43_20250107T18:26_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEGATIVE] Hello, good afternoon. Um, I'm calling because I'm trying to check on, on the, uh, eligibility, like, uh, this is my husband's plan, but I'm having problems because they're, they're charging me a bill saying that my son is not under the plan.
[AGENT][NEUTRAL] OK, um, so you're just going to see.
[AGENT][NEUTRAL] Who's like who's on the policy?
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah, if he's on the policy and also because um they said that they need to refile it if he is because they sent them a letter saying that he wasn't on the policy so I'm just verifying all of that.
[AGENT][POSITIVE] OK, yeah, absolutely. Can I have that policy number please?
[CUSTOMER][NEUTRAL] Yeah, should be a second, sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, the group number is 21265.
[AGENT][NEUTRAL] All right, and then is there like a member ID or a policy certificate number on there?
[CUSTOMER][NEUTRAL] Well, they just have an outpatient, yeah, certificate number, yeah, it's 01719341.
[CUSTOMER][NEUTRAL] ML 8.
[CUSTOMER][NEUTRAL] First time I'm gonna tell you.
[AGENT][POSITIVE] Perfect. And then can I have your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, from mine or my husband's cause it's, it's under his name.
[AGENT][NEUTRAL] For yourself.
[CUSTOMER][NEUTRAL] OK, it's [PII] and it's uh [PII].
[AGENT][POSITIVE] Wonderful. And then I do just need to verify a few other pieces of information if you could verify for me the mailing address, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Wonderful and then would you be able to verify for me the email on file?
[CUSTOMER][NEUTRAL] Oh, I don't know if he put his. It'll be [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][POSITIVE] Awesome thank you so much and then lastly if I could just get a good call back number my friend.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is the name of your son that you're looking to see is covered?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, I do see him on here. I don't know. I show that he's current and active, so I'm not exactly sure um why they'd have information stating otherwise.
[CUSTOMER][NEUTRAL] I don't, I don't know. I figured he was, but, you know, you never know with those people, so I was like go again.
[CUSTOMER][NEUTRAL] Um, cause they said they, they received a formal letter saying that he wasn't under the American Public Life plan. cause it's, it's, um,
[CUSTOMER][NEUTRAL] You know, it's just a deductible, so.
[CUSTOMER][NEUTRAL] I don't know, I'm confused by it.
[AGENT][POSITIVE] Yeah, no, I'm really sorry about that. What was the name of like the, do you know the name of like the facility or the provider you went to?
[CUSTOMER][NEUTRAL] So what can I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, they said the provider was [PII].
[CUSTOMER][NEUTRAL] Um, and the date they have on here is uh [PII].
[CUSTOMER][NEUTRAL] was when they activated the date or they sent out the bill.
[AGENT][NEUTRAL] That was like the day that he received service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] But the, the people, the, they're going like through, I guess a group, and the group is called Pediatrics Medical Group.
[AGENT][NEUTRAL] Yeah, I'm not showing that like any claims were put on file for [PII], um.
[AGENT][NEUTRAL] So I'm not exactly.
[CUSTOMER][NEUTRAL] They have another date here, [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But that's when my other insurance paid out the other amount.
[AGENT][NEUTRAL] OK, so I guess the dates like I the only way I can search it is like by the date of service so the date like you received the the treatment or had the visit.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, the data service they say here is um [PII].
[AGENT][NEUTRAL] All right, it doesn't look like anyone placed a claim on file with us for him.
[AGENT][NEUTRAL] So they're more than welcome to resubmit that claim.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, no time limit.
[CUSTOMER][NEUTRAL] So that I tell him to, to read.
[CUSTOMER][NEUTRAL] Um, or, well they said that he, I don't know how it works, because they gave me their phone number and they said if you can call them, so I don't know.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, what's that phone number?
[CUSTOMER][NEUTRAL] Uh, their phone number is [PII].
[AGENT][NEUTRAL] OK, yeah, I can do a 3 way call and give them a call and add them in, OK?
[CUSTOMER][NEGATIVE] Oh yeah, sure, cause they're telling me it's a final notice. I didn't even get the first notice, so I, I don't know.
[AGENT][NEUTRAL] Yeah, I'm not really sure, but I have [PII] to call, is that right?
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] Alright, Ms. [PII], I'm gonna put you on a brief hold. I'm gonna call them and then I'll join the call, um, so it can be a 3 way call, OK?
[CUSTOMER][POSITIVE] OK, perfect. Thanks.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling patient services espanol precion Nue.
[CUSTOMER][NEUTRAL] If you are a patient, a patient guarantor or guardian, please press 1. If you represent an attorney's office, please press 2.
[AGENT][NEUTRAL] Are you still there with me, [PII]?
[CUSTOMER][NEUTRAL] If you would like to make a payment or check your balance using our automated system, please press 1. For your security, our patient service representatives are unable to process payments or collect any payment information directly, but we'll transfer you to the automated system once you are ready to pay. If you would like to speak with a patient service representative prior to making payment, or if you would like to set up a payment arrangement, please press 2.
[CUSTOMER][NEUTRAL] We also offer the option to manage your account including make a payment or set.
[CUSTOMER][NEUTRAL] Please have your ID number or reference number and insurance card ready for the next available patient services representative. Please note that your call may be monitored or recorded for quality assurance. To ensure your privacy, we are only able to discuss account information with the patient or the guarantor of a minor patient. Patient privacy laws require that we obtain express permission from the patient if you wish us to discuss account information with anyone other than the patient.
[CUSTOMER][NEUTRAL] If you have questions in regards to your insurance benefits or your explanation of benefits, please contact your insurance company to assist you.
[CUSTOMER][NEUTRAL] Your call is important to us. Please note that we typically experience higher wait times on Mondays and Tuesdays and every day between [PII] Eastern Standard Time. Thank you for your patience. The first available agent will be with you as soon as possible.
[CUSTOMER][NEUTRAL] Please remain on the line and your call will be answered by the next available representative. Your call may be monitored or recorded for quality or training purposes.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Thank you for calling Pediatrics. [PII] speaking. May I have your ID or reference number, please?
[CUSTOMER][NEUTRAL] Hi, [PII], yeah, um.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh, I'm here.
[CUSTOMER][NEUTRAL] Yeah [PII], I have my um my insurance company on the line as well.
[CUSTOMER][NEUTRAL] Um, because I was having an issue and they said that we had to call back so they can.
[CUSTOMER][NEUTRAL] I'll just let her take over. Is that OK?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] Let me just give you the guarantor number first um it's 12887119.
[CUSTOMER][POSITIVE] Hey, I do have that account pulled up and to whom do I have the pleasure of speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And if you could verify a few things first, if you could verify.
[CUSTOMER][NEUTRAL] Responsible party that's listed on file, their full name, date of birth, and the full mailing address?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's for [PII]. It's uh [PII] and it's [PII].
[CUSTOMER][NEUTRAL] Thank you for that. And if you could verify [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Thank you so much for that information. It looks like we do have a balance here of $406.92. How can I help you with that?
[CUSTOMER][NEUTRAL] Um, they said that they did a claim to my gap insurance, and my gap insurance said that, uh, well, they sent you guys a notice saying that he wasn't under the policy, but I have the young lady there, um, from my gap insurance from American Public Life, and she can, I, I don't know what you gonna need from her.
[CUSTOMER][NEUTRAL] OK, if, if she can verify it and I can just take her name and uh reference number and I can get it resubmitted.
[AGENT][NEUTRAL] OK, hi, my name is [PII], and may I have your name as well? I'm sorry, I didn't quite catch it at the beginning.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much and um.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Just to make sure we're talking about the right patient, I'm looking to verify for [PII], is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, perfect. I do show that he is current and active with us with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can get that claim resubmitted if you could verify that I just wanna make sure I have the correct information to to submit. Let me just get into the insurance here because have it on file.
[AGENT][NEUTRAL] Absolutely I can verify that.
[CUSTOMER][NEUTRAL] OK, so I do have policy number as 01719341.
[CUSTOMER][NEUTRAL] M as in mom, L as in love, 8.
[AGENT][NEUTRAL] Correct?
[CUSTOMER][NEUTRAL] OK, and then group number I have 21265.
[AGENT][NEUTRAL] I have group number is 24679.
[CUSTOMER][POSITIVE] But the policy number was correct.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and then [PII], uh, is the subscriber on the coverage?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have the employer listed as a freight liner for the coverage.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, and then the claims address I I show is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] We do have an updated claims address that I can give you.
[CUSTOMER][NEUTRAL] OK, I'll take that.
[AGENT][NEUTRAL] Perfect it would be made out the same to APL claims, um, and then it is [PII] Box 248,950.
[AGENT][NEUTRAL] And that is in [PII], [PII].
[AGENT][NEUTRAL] And then our zip code here is [PII].
[CUSTOMER][NEUTRAL] OK, so I have [PII].
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] OK, and then what about uh a phone number for provider services?
[AGENT][NEUTRAL] Yeah, um, our phone number here is [PII].
[CUSTOMER][NEUTRAL] OK, and then do you guys have like a payer ID or EDI number?
[AGENT][NEUTRAL] We do have an electronic payer ID. That number is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do you mind holding while I get this information submitted?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Thank you. 01 more question, what type of plan is this one? Is it a PPO, HMO?
[AGENT][NEUTRAL] Um, we're their secondary. It's like a gap policy.
[CUSTOMER][NEUTRAL] Yeah, it's a gap. OK, alright, I will go ahead and do that. Alright, and then you said you don't mind holding while I get this submitted.
[AGENT][NEUTRAL] I don't mind holding.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, thank you so much. One moment please.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] Thank you for holding in your patience. I did get that insurance information submitted and now the account is pending insurance approval, and normally the turnaround for that is about 45 to 60 days and then once the insurance does process, we'll send out a new statement if there's a patient responsibility left.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm not sure if they're gonna pay in full if they do end up paying in full, then we would not, we wouldn't send it like another letter or statement or anything because they wouldn't be anything owed on the account and if something did go wrong with the policy, we would give a, give a call right away and also I wanted to see if [PII] if you had a reference number for the call.
[AGENT][NEUTRAL] Absolutely, my reference number is Ali A L L I E B and then today's date and then likewise [PII], do you have a reference number for your call?
[CUSTOMER][NEUTRAL] No, ma'am, I don't, we don't have reference numbers.
[AGENT][POSITIVE] Perfect just making sure and then awesome well thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem, do you guys have any other questions or concerns?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright well thank you have a wonderful day ladies.
[AGENT][POSITIVE] Our pleasure thank you.
[CUSTOMER][POSITIVE] You too bye thank you bye bye.
[AGENT][NEUTRAL] [PII], is there anything else I can do for you today?
[CUSTOMER][POSITIVE] No, that's all. Thank you for help.
[AGENT][POSITIVE] OK, my pleasure. I'm very glad I could help you with that. You take care and have a wonderful day.
[CUSTOMER][POSITIVE] You too and happy [PII]. Bye-bye.
[AGENT][POSITIVE] Likewise, Happy [PII].
[AGENT][NEUTRAL] Bye bye.