AccountId: 011433970860
ContactId: 663c2120-23d9-4f8d-a82c-8cf0b371694d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580530 ms
Total Talk Time (AGENT): 247209 ms
Total Talk Time (CUSTOMER): 340911 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/663c2120-23d9-4f8d-a82c-8cf0b371694d_20250127T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from Worldwide United Enrollment Agency, a mutual member of sorts on my back line, um.
[CUSTOMER][NEUTRAL] So the member is under the BWA plan enrolled privately, not through employer, and for whatever reason, when there was a claim submitted by his hospital facility, they got a kickback stating that you guys needed to confirm he doesn't have secondary coverage in place, Medicare, supplemental or otherwise.
[CUSTOMER][NEUTRAL] We're advised to reach out to you. He just needs assistance because he's not sure of the whole process, so I have him on the back line and I was hoping we can.
[AGENT][NEUTRAL] OK. Can you give me your name again, the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And who are you with [PII] or calling on behalf of?
[CUSTOMER][NEUTRAL] Worldwide United enrollment agency.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Of the members enrolled through Health group.
[AGENT][NEGATIVE] Through you're cutting in and out.
[CUSTOMER][NEUTRAL] A joint health group is the plan administrator for them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do they have a policy number?
[CUSTOMER][NEUTRAL] Yep, I have a 6830.
[CUSTOMER][NEUTRAL] 64,070.
[AGENT][NEUTRAL] Now that's not one of our policy numbers. Spell the spell the.
[CUSTOMER][NEGATIVE] I know that's the problem. It's supposed to have been submitted to a NovaCare directly and it wasn't, it was submitted to you guys.
[AGENT][NEUTRAL] OK, spell the first and last name.
[CUSTOMER][NEUTRAL] Uh, it's 6, last name, sorry, [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the last name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], that's [PII], sorry, [PII].
[AGENT][NEUTRAL] Oh, the first name, the first name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mondays are like Fridays so I guess.
[AGENT][POSITIVE] It's Friday on a Monday, so definitely I wanna make right needed an extra day so.
[CUSTOMER][NEUTRAL] Yeah, Monday's your brain fog for the weekend and Friday because it's tired for the week.
[CUSTOMER][POSITIVE] Yeah, exactly.
[AGENT][NEUTRAL] So so you're saying that the claim should have been submitted to NovaCare, but it went to.
[CUSTOMER][NEGATIVE] The hospital submitted to you guys and I don't know how that ended up happening because it's not even anywhere on their ID cards. Yep. So when we tried to reach out to the hospital to get it submitted properly, they said that you guys kicked back and said he needed verification that he didn't have secondary insurance. So I'm kind of unclear as to how to get him resolved. We did contact the NovaCare also and they told us that we had to reach out to the hospital, so.
[AGENT][NEUTRAL] Oh, should have gone over there. OK.
[AGENT][NEUTRAL] Is Novacare a healthcare facility or an insurance company?
[CUSTOMER][NEUTRAL] Uh, NovaCare is the underwriter for the BWA policy, which American Public Life apparently is an underwriter for through the private sector.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, OK. One second.
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] And is it an individual policy or is it a family policy? Do you know? Or single parent, single parent policy?
[CUSTOMER][NEUTRAL] That's a family policy.
[CUSTOMER][NEUTRAL] It's actually it's mom or sorry, dad plus his, he's got twins.
[AGENT][NEUTRAL] OK, so I do show up, I do show a policy for him. Would you happen to have the address? Let's verify that.
[CUSTOMER][NEUTRAL] [PII] old.
[CUSTOMER][NEUTRAL] Yeah, uh, it's gonna be [PII].
[AGENT][NEUTRAL] All right, so I do show that he has a limited hospital indemnity policy with American Public Life.
[CUSTOMER][NEGATIVE] Yeah, it just shows up as a Novacare for the claims process or I don't know why.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I'm not sure as to why he's getting that kickback, but the claim he has is pending I guess in November.
[AGENT][NEUTRAL] Yeah, let me give you the
[AGENT][NEUTRAL] Yeah, I think it could be the policy number if that's what you gave me, it's definitely uh not unique to American public life. So.
[AGENT][NEUTRAL] That may be his employee number that you gave me, but not the policy number. Let me give you the policy number.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep, I'm here can you hear me?
[AGENT][NEUTRAL] Oh, now I can. So like you went away.
[CUSTOMER][NEUTRAL] I'm here. I don't know why it does that. No, it's just the noise reduction on the headsets for some reason it goes like silent, but I'm still here.
[AGENT][NEUTRAL] Yeah, I think
[AGENT][NEUTRAL] OK. Yeah, so I guess that's kind of a, a good thing. Um, so that number you gave me is like his member ID number, that's a unique member ID number, may have been assigned by.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, BWA I guess I don't know, but the APL policy number is 256.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1553.
[AGENT][NEUTRAL] So when the claim is submitted, uh, that policy number needs to be on the claim.
[CUSTOMER][NEUTRAL] OK. Do you know if there's anything noted there that is asking if he has secondary or supplemental coverage? Because he says he does not have anything else in place and he doesn't go on to Medicare yet for like 2 years or something.
[AGENT][NEUTRAL] I'm thinking that maybe
[AGENT][NEUTRAL] Yeah, yeah, yeah, I don't and I mean, from, from what I see, I don't show any other coverage and he would know that if he had other coverage.
[CUSTOMER][NEUTRAL] A year, a year.
[CUSTOMER][NEUTRAL] Yeah, but the hospitals didn't this is the thing I'm now unclear as to how to handle this because the members claims phone number that he has advises him to call the hospital, which we do the hospital this isn't against you. I've just given you kind of a relay of what happened. Uh, the hospital facility tells us that we have to contact the American public because they're denying the claim because they want to verify with the member if he has secondary coverage as well as the BWA plan, so we are advised to call you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I get it. I understand.
[CUSTOMER][NEUTRAL] And have that sorted out and then from there they said that we shouldn't have any further action that it'll automatically go through the claims process from there that there should be no need for a call back so I don't know what to do to help them.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so then once all that's figured out it'll continue the process will continue and the claim will be submitted to APL.
[CUSTOMER][NEUTRAL] Yeah, but they're saying that you guys are the ones that signing off on that he doesn't have secondary and allowing the claim to continue on with processing that the hold up is with American public.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] I don't show any documentation regarding what you just said. I don't show any claims for any of them.
[AGENT][NEUTRAL] Uh, we wouldn't have denied anything citing that remark that you just said, so I'm not sure what they're talking about.
[CUSTOMER][NEUTRAL] this was
[CUSTOMER][NEUTRAL] It was a data service from 11 2 that they're showing.
[AGENT][NEUTRAL] As it relates to
[AGENT][NEUTRAL] Yeah, I don't show any claims on file for anyone. Is it for [PII]?
[CUSTOMER][NEUTRAL] Yeah, he had to go get a um.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Some type of an outpatient procedure done.
[AGENT][NEUTRAL] Yeah, so I'm looking under [PII] Dad and [PII] is a dependent son as well, and I don't show a claim for anyone.
[CUSTOMER][NEUTRAL] Can be.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, I'm gonna go back to the hospital facility and see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I guess the question would be if they're receiving a denial, then they need to verify who it's from. I can tell you we've not received a claim for any of the three, so we wouldn't have processed an explanation of denial without a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no worries. I'm just getting bits and pieces so we're trying to just narrow down like the best way to proceed I guess from here, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you may want to provide the policy number because they could be sending it to the incorrect place maybe. I don't know.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna
[CUSTOMER][NEUTRAL] But let me ask this because they have billing that's to be submitted to the Gun Highway address for the claims billing that's not your address though, correct?
[AGENT][NEGATIVE] Correct, it's not.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I'm sorry, I'm just at a loss because he, he has no entity listed for you guys other than in like his policy documentation. There's no phone number. There's no website, and there is no claims information related to American Public Life. Everything is directed to a NovaC cares on a gun highway, which is where all the claims are submitted, so I'm unclear as to how you guys got the claim then.
[AGENT][POSITIVE] OK, perfect. OK.
[AGENT][NEUTRAL] We do not have a claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well, no, but his file anyways like in general.
[AGENT][NEUTRAL] As far as his policy, have him having a policy with us? Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, you guys show active September to current.
[AGENT][NEUTRAL] [PII] and currently active at this time. Mhm.
[CUSTOMER][NEUTRAL] OK, I'm at a loss now. um, alright, let me speak with the members, see what I can do with the hospital facility, and I'm gonna check with my benefit supervisors because I don't know what to do now.
[AGENT][NEUTRAL] Yeah, so I'm wondering if the hospital may need the correct billing address for claims? I'm not for sure.
[CUSTOMER][NEUTRAL] They said they had all the correct information. They just didn't have verification that he didn't have secondary and that an American public was unwilling to process the claim as his primary until they verified if he had a secondary coverage or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I don't show any claims received, so it's like I don't know why we would they indicate the APL would say that. I can understand we've received a claim and denied it for other coverage.
[CUSTOMER][NEUTRAL] Yeah, I wonder if the facility's just doing this because they don't feel as if their claims payout's gonna be high enough.
[AGENT][NEUTRAL] Yeah, I don't know.
[CUSTOMER][NEUTRAL] I've seen that happen a lot.
[AGENT][NEUTRAL] Oh, really? Mhm.
[CUSTOMER][NEUTRAL] Alright, I'm gonna, yeah, I'll speak with my benefit supervisor and see what they advise other than contacting the hospital facility again.
[AGENT][NEUTRAL] And before I let you go, Destiny, OK, so Worldwide United is is it.
[CUSTOMER][NEUTRAL] We're just the enrolling agency.
[AGENT][NEUTRAL] Enrolling agency you're the enrollment platform, OK.
[CUSTOMER][NEUTRAL] That's it. Mhm. Yeah.
[CUSTOMER][NEUTRAL] Sort of we're not even the platform. Our agents enrolled through a joint health group this member into this plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEGATIVE] Uh, we just offer additional support because insurance obviously is a mess.
[AGENT][NEUTRAL] I just wanted to, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just needed it for documentation purposes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's fine, no worries, I will let them know and uh no, I'll follow up if need be. I gotta talk to my boss real quick, see what they suggest.
[AGENT][NEUTRAL] OK. Did you have any?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alright, Destiny if no other questions, thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you you too appreciate it bye.
[AGENT][POSITIVE] Uh bye-bye. You're welcome.