AccountId: 011433970860
ContactId: 68f9a89a-8f0d-4f29-874b-dab188970611
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387739 ms
Total Talk Time (AGENT): 115488 ms
Total Talk Time (CUSTOMER): 122404 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/68f9a89a-8f0d-4f29-874b-dab188970611_20250324T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][NEUTRAL] Good, I'm calling from a provider's office. I'm just calling to follow up on the status of the claim. I got a letter in the mail.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From benefits in a card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not really sure what it means though.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Do you need all the zeros in front of it?
[AGENT][NEUTRAL] No, you can just give me the numbers, the, the numbers after the 0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 249-873-1.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] And may I have the date of service that you're calling in regards to?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total bill please.
[CUSTOMER][NEUTRAL] Uh, 221.
[AGENT][POSITIVE] Thank you so much for that information. I'm pulling it up for you now.
[CUSTOMER][POSITIVE] Thank you honey.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it looks like it is pending, it is awaiting information to confirm eligibility for the benefits.
[CUSTOMER][NEUTRAL] So does that mean you're waiting for information from the patient or from the employer?
[AGENT][NEUTRAL] It's for, let me pull that back up for you.
[AGENT][NEUTRAL] It say benefits in a card, so it's waiting for information from them.
[CUSTOMER][NEUTRAL] OK, I actually just called them and they're like they probably already have the information. We're just sending you a letter to tell you that you know where we are in the process, which just doesn't tell me anything about the process. Um, I guess my concern is is that his wife is here for her appointment as well, so is this gonna cause an issue for her?
[AGENT][NEUTRAL] Let me pull up their eligibility date for this.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because we did an insurance verification prior to him even coming in it said that it was active.
[AGENT][NEUTRAL] Yes, it's showing that it's active. Let me see what type of policy that they have.
[AGENT][NEUTRAL] Yes, it's showing that it's active, but we still have to make sure that that member was active at that date of service because the way that this policy works this is considered a weekly premium policy, so we have to make sure that at that time of service, he was eligible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long does that normally take? because it's been.
[CUSTOMER][NEUTRAL] Um, it's there.
[AGENT][NEUTRAL] This was sent out on [PII]. This was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So from [PII] that's a long time though because we we submitted this on [PII] so it took from [PII] to 317 to even get sent over to card in a box or I keep want to say card in a box that's not it bear with me um benefit to the card, yeah.
[AGENT][POSITIVE] Benefit in the car.
[AGENT][NEUTRAL] Yes. So, looks like we received it on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] We received it on [PII] and
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] It was reviewed on [PII], so we're still waiting for that information. Now once they submit that information in that examiner will then go back in there and process that claim at that time, but we still have to wait for that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you confirm for me that his yearly max is only 500?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] So in regards to the member's benefits, verification of coverage does not guarantee the payment of the claim. It does show that the calendar year max for this member is $500.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm just gonna give them a heads up because I bet you they have no idea.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um, so we just need to wait and file her his wife's appointment as normal and go from there.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty I appreciate your help.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life, [PII]. You have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye.