AccountId: 011433970860
ContactId: 7f5df99f-7896-4d60-885f-1b6683c1b128
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657820 ms
Total Talk Time (AGENT): 280700 ms
Total Talk Time (CUSTOMER): 199591 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/7f5df99f-7896-4d60-885f-1b6683c1b128_20250422T14:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm calling on behalf of a um of Chris's Health, uh, Mother Francis Hospital.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I am trying to speak with uh whoever handles claim status. I don't know if I'm on the right.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I can help you with claim status. Yes, status, and what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] D 43728264.
[AGENT][POSITIVE] OK, thank you, but don't worry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is not the American Public Life policy number, that is 90 degree benefit number. Does the member also have a plan with APL?
[AGENT][NEUTRAL] Or were you trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh yes, I think so, yeah.
[AGENT][NEUTRAL] You were just trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Well, I'm, I'm having a hard time with the, the insurance cause it's not, um, so I called the number that is on the card and this took me to you. So I don't know, I might have the wrong, that's why I'm a little unsure.
[AGENT][NEUTRAL] So you
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. Did you call [PII]?
[CUSTOMER][NEUTRAL] It's benefits in a.
[AGENT][NEUTRAL] 686-0618.
[CUSTOMER][NEUTRAL] I called [PII].
[AGENT][NEUTRAL] So, go ahead.
[AGENT][NEUTRAL] OK, so for the D number for 90 degree benefits, it's option.
[CUSTOMER][NEUTRAL] Yeah, 880.
[AGENT][NEUTRAL] And one, because depending on the object.
[CUSTOMER][NEUTRAL] Which option, I'm sorry?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 1
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. I'll try that. Thank you. Sorry about that.
[AGENT][NEUTRAL] Now, some of these members also have a policy.
[AGENT][NEUTRAL] Oh, that's OK. Some, I can transfer you. Some of these members also have policies with APL, but they would have a different number. So it just depends on the type of plan they have. Some have just 90 degree benefits, some have 90 degree benefits and APL, and some just have APL. So do you, uh, I can try, I can't search by date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can try and search, do a name search to see if they have a policy with us before I connect you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, yes, it's [PII].
[AGENT][NEUTRAL] I OK, I cannot search by date of birth. I would have to try by the name.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Oh, the name is [PII]
[AGENT][NEUTRAL] OK, let me see if I can locate someone in our system by that name.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] What's in.
[AGENT][NEUTRAL] Hi, [PII], are you still there?
[CUSTOMER][POSITIVE] Yes, yes, I'm here. Yes.
[AGENT][NEUTRAL] What state does he live in? Are you able to hear me?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII]. Uh, it's going off and on. Uh, it's, um, he lives in [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I may have located a policy. What, um, any information provided would be a verification of benefits and not a guarantee of payment. What is his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. So I did locate a policy for him, but it's no longer active. The policy that he had had with APL, um, this policy was in effect the most recent one from 2-12-2024 to 11-17-2024. Is your data service within that date range?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see. It's for, yeah, [PII].
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] OK, so again any information provided would be a verification of benefits and not a guarantee of payment. Let me see if we received a claim for him.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the correct policy number that you should have had for APL is 02.
[AGENT][NEUTRAL] 467-577.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it was 64-2024, and what's the total bill?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, it was for 5,536.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive a claim and it was, it has been processed. This was received back on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 347.
[AGENT][NEUTRAL] 8020.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $100.
[AGENT][NEUTRAL] And that was on single check 186.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1298.
[AGENT][NEUTRAL] The check did clear on 7-1120.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] And there was a along with the payment states the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] What's this process in or out of network?
[AGENT][NEUTRAL] Uh, this is a limited benefit plan that he has. This is not or had. This is not major medical insurance.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So it only, OK, so you pay, um, and I guess that's why I was calling because it, it was $100 that like that's.
[AGENT][NEUTRAL] $100. That's the maximum benefit for this.
[AGENT][NEUTRAL] Yes, ma'am. That's the
[AGENT][POSITIVE] Maximum benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the
[AGENT][NEUTRAL] For the imaging on the limited benefit plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is the patient responsible for?
[CUSTOMER][NEUTRAL] Like any balance or it's that?
[AGENT][NEUTRAL] We do not determine. Yes, ma'am. Do we do not determine patient responsibility here at APL. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um,
[AGENT][NEUTRAL] And if you, mhm.
[CUSTOMER][NEUTRAL] Is there a specific network that is used? Uh-huh, go ahead.
[AGENT][NEUTRAL] Multiplan is the network that this plan participates.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It with
[CUSTOMER][NEUTRAL] Multi plan, OK.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. OK, perfect. And um the other thing that I would need is a reference number.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date. And then also if you were to need a copy of this explanation of benefits, you should be able to print it now that you have the claim number, Dora, by going to our website at [PII]
[CUSTOMER][NEUTRAL] 360. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Let me just confirm, [PII]. [PII]?
[AGENT][POSITIVE] Yes, ma'am, and make sure to put a D on the word secured. It's secured.
[CUSTOMER][POSITIVE] [PII]. OK. [PII]. OK. And I should be able to pull the, OK, yeah, cause I don't, don't have one. I was gonna ask you for that. OK. I'll, I'll go in the website and get it then. All right. Thank you so much for all your help today and I'm sorry for, I called different numbers and I was having.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, yes sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, no worries. Yes, ma'am. Worries, um, not at all. So again, if that is all I can help you with at the moment, [PII].
[AGENT][POSITIVE] Alright, thank you for calling APO and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Yes, yes. Thank you so much for your help.
[AGENT][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.