AccountId: 011433970860
ContactId: 6c22646d-01be-46fa-a20e-c813f6446b20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533719 ms
Total Talk Time (AGENT): 143608 ms
Total Talk Time (CUSTOMER): 257010 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/6c22646d-01be-46fa-a20e-c813f6446b20_20250521T12:31_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I'm calling from a provider's office and I'm not familiar with the insurance that was taken during our, um, uh, walk-in clinic, and we're trying to figure out if this is something that, that is, uh, insurance that's in network with us or uh what type of insurance it is. I'm not familiar with it, to be honest with you, so we're not sure what, what type of insurance the patient has. Is there some way that you can help me with it?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I can definitely
[CUSTOMER][POSITIVE] And when I went through the options, thank you.
[AGENT][POSITIVE] You're welcome. Um, I can definitely go over the coverage in the policy with you. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and my last initial is [PII] and my direct line and I'm with Ortho Cini. My direct line is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] A as in apple, P as in Peter, L as in llama, 20,000.
[AGENT][NEUTRAL] OK, what on the, on the card, um, do you see APL to the top left?
[CUSTOMER][NEUTRAL] I see well we don't have the scan card which is also causing concern, but it says apparently the person that took the information said verified by card and then they didn't scan it and it says American Public Life.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, because that's not a policy number, but I can search with the member's first and last name or full social would be better if you have it. If not, I can search with the first and last name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. We do have uh a full social security number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which we don't usually have that, but it's [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. So this policy, um, it's a hospital indemnity policy, so it's a limited medical policy. Um, however, this um particular, that's probably where that number came from, this particular um policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't administer the product to them, so I can give you the number to web TPA and I can transfer you over to a rep to go over the benefits, um, but this policy has been
[CUSTOMER][NEUTRAL] Web TPA OK.
[AGENT][NEUTRAL] But this policy has been active since [PII] and it is a limited medical benefit policy.
[CUSTOMER][NEUTRAL] OK, so he does have like doctor visits, specialist visits?
[AGENT][NEUTRAL] Um, so that's what we're getting ready to call web TPA for so we can go over the coverage.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much.
[AGENT][POSITIVE] You're welcome, and [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, do we have the right member ID then?
[AGENT][NEUTRAL] Oh, yes, let me give you their policy number. Um, it's 212.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3881.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 2123.
[CUSTOMER][NEUTRAL] You cut out. I'm sorry.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] Oh, it's OK, 3881.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome and thank you so much for calling APL. Did you need the number to web TPA also, or would you just like me to transfer you?
[CUSTOMER][NEUTRAL] Yes, well, both.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, the phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you. I appreciate it.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Have a great day.
[AGENT][NEUTRAL] Hold on one moment for your transfer. You're welcome.
[CUSTOMER][POSITIVE] Uh-huh, thank you.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to WebTPA, the administrator for the Limited Benefit Health Insurance program underwritten by American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account, such as an address change, add or drop a dependent, or you wish to modify your coverage in any way, please call American Public Life at [PII].
[CUSTOMER][NEUTRAL] For questions regarding pharmacy services, please contact Caremark at [PII].
[CUSTOMER][NEUTRAL] Please note, using a PPO provider can reduce the amount you pay out of pocket for services you receive.
[CUSTOMER][NEUTRAL] Network discounts continue after you have exceeded the maximum allowed visits, testing days, and hospital confinement days. Please call [PII] to locate a provider in the Beach Street PPO network.
[CUSTOMER][NEUTRAL] This call may be recorded for quality assurance and training purposes.
[CUSTOMER][NEUTRAL] If you are calling on behalf of a hospital, physician, or other provider of services, please say provider or press one now.
[CUSTOMER][POSITIVE] I can help you with things like eligibility, benefits, claim status, and more.
[CUSTOMER][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] Representative
[CUSTOMER][NEUTRAL] Sorry,
[CUSTOMER][NEUTRAL] I can help you check the status of a claim, check eligibility, and more.
[CUSTOMER][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] Eligibility and benefits.
[CUSTOMER][NEGATIVE] I'm still having trouble understanding.
[CUSTOMER][NEUTRAL] Let me transfer you to someone who can help, but first I need some additional information.
[CUSTOMER][NEUTRAL] Please say your first and last name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Please say your first and last name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You're calling from [PII].
[CUSTOMER][NEUTRAL] Say yes if this is your preferred callback number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Otherwise, please say your 10 digit callback number.
[CUSTOMER][NEUTRAL] Please say or enter your nine-digit tax ID number.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Let's try this another way. Please enter your number.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, thank you so much for holding. I was trying to get a representative, but it's an automated system and it's asking for like your tax ID. So I'm just gonna call and connect you and then you can enter that information because I, I don't know it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right, sure.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Man.
[AGENT][NEUTRAL] I have to write them over.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the Limited Benefit Health Insurance program.