AccountId: 011433970860
ContactId: 88cab5b4-b7e0-4d68-9b8c-5d43ac0daee9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 593460 ms
Total Talk Time (AGENT): 313275 ms
Total Talk Time (CUSTOMER): 230671 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/88cab5b4-b7e0-4d68-9b8c-5d43ac0daee9_20250604T13:25_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] Hey, [PII]. My name is [PII], and I'm the billing supervisor for Triad Pediatrics. And we had a family that presented with a card this morning for APL. And one of the girls called, well, she couldn't verify whether or not we are a network. I know that we do have several providers that are credentialed with multi-plan.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] But I was trying to register on the website so I would be able to look at EOBs and claim status and I'm entering the tax ID and then it told me to call customer service and enter option 4.
[AGENT][NEUTRAL] OK, [PII]. So you're trying to check the claim status for a member that there's been a claim filed for?
[CUSTOMER][NEUTRAL] Well, this is the first time we've ever seen them. This is the first time we've ever seen them, period. And so I just wanted to register on the website so I would be able to look at EABs and claim status. Um, we did tell the family that we would see them today and that if for any reason the claim came back that we're not participating, we would adjust the charges this one time, um, because we can't get a clear answer to whether or not our provider is credentialed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] With, uh, with multi-plan, you all have taken to multi-plan. Is that correct?
[CUSTOMER][NEUTRAL] Well, so I have several patients that have it, and I have um several of our providers, to my knowledge, they were all, any one provider that's credentialed, usually we credential all our providers that I've had some issues in the past with some of our PAs and this patient happens to be seeing a PA um they didn't present, they didn't give us a card ahead of time. In other words, they just came in and I didn't want to not see them being that it's a child.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right. I understand. OK, [PII], so you're just
[CUSTOMER][NEUTRAL] Um, so, long story short, yeah.
[AGENT][NEUTRAL] Yeah, so you're really trying to find out about the portal is what you're needing information on. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, I would, I would love to know if, if you know if we are, if you can find one of our providers that are credentials, I don't know what information I need to give you. I don't know if the girl at the front desk didn't have enough information. Is there a way I can do that while I'm on the phone with you or or you just for the portal?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me pull the member's information up and I'll be able to better be able to answer all of your questions at that point once I can see the type of policy they have with us. So what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, you can just use my cell. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the member's policy number?
[CUSTOMER][NEUTRAL] So I've got 02611165.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get that information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information, [PII], that I can provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you would please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Excuse me. I was trying to hold that.
[AGENT][POSITIVE] Oh, you bless you.
[AGENT][POSITIVE] Bless you.
[CUSTOMER][NEUTRAL] Let's see, patient's name is [PII].
[CUSTOMER][NEUTRAL] And let's see here. So, [PII].
[AGENT][NEUTRAL] 2. Wait, and maybe I heard you miss.
[AGENT][NEUTRAL] OK, maybe I heard the policy number wrong. I understood you to say 02611165.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, this is the dependent. Do you need the, do you need dad's name, the policy holder?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Well, you can give me the policyholder's name.
[CUSTOMER][NEUTRAL] This is just the account number.
[CUSTOMER][NEUTRAL] OK, I'm just going off with the front desk gave me, but I've got [PII] for the policyholder.
[AGENT][NEUTRAL] OK. And what is the child's name again?
[CUSTOMER][NEUTRAL] I wonder if she transposed the account number. I'm showing [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Let me see if she's 35424. Give me one second. I'm just trying to see if she, uh, that's exactly what she did. I found it. She, she transposed one number and the account number because, OK, the patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, cause this
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, um, any information that I provide for you today [PII] would be a verification of benefits and not a guarantee of payment. So I do show that [PII] is a dependent on this limited benefit plan. Now as far as any network questions that would all go through multi plan.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We don't have access to that because we're not a major medical insurance company, so there's no credentialing with us, but to find out if the provider is, you know, affiliated and participates with multi plan, then you would have to speak to them. I can give you their phone number if you do not have that and I can also connect you, but their number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then as far as the portal.
[CUSTOMER][NEUTRAL] And for the
[AGENT][NEUTRAL] As far as the portal goes, that is only for checking claim status so if we do not have a claim on file yet for the member, then it's not going to recognize that information we would have had to have received a claim with that tax ID number and it been processed before you could do that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that makes sense.
[AGENT][NEUTRAL] Yes, so that's why.
[CUSTOMER][NEUTRAL] Um, I just have one more question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is there a group number that we need to be filing with this? I just see on the card the policy number. Is there a group number or do these plans not have one?
[AGENT][NEUTRAL] OK, on the, on the ID card, there should be a group number of 70087.
[CUSTOMER][NEUTRAL] 700.
[CUSTOMER][NEUTRAL] OK, where, and that would be normally on the front of the card because I'm looking at the front of the card and I just show a policy er certification number, which is the one I gave you and then there's at the very bottom, it says medical ID number but that starts with an alpha character of D as in dog.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that is a 90 degree benefit number is what that indicates. Um, give me just a second, let me now they may have received some type of temporary card like from their enrollment company that would not have had their group number on it, but in looking, let me just look at the, the ID card that we.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So, yeah, cause at the top of the card, it just says American Public Life.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it tells me to file claims to IMA INC.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so I guess they have stopped putting the group. It did, OK, so they changed their ID cards a little bit, um, because I am looking at it now, but, um, the and it used to have the group number on there, but the group number is the 70087.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 70087. OK.
[AGENT][NEUTRAL] And I will let you know too, as far as the portal goes, we have recently made an update over this past weekend to the portal, so I don't know yet cause it's too new and we're still working through some, some kinks and some pains with it as with any new system. But sometimes it is harder to locate the claims or how it was in the past, checking status in the portal because these claims do go to IMA.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] To that [PII] address. And so sometimes when it comes to their clearing house, some of the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Numbers change and it has made it more difficult to check claim status for this type of policy. So I don't know yet about the new portal, you know, if that's going to be the same issue or not, but in the event that you will have any difficulty or it's still is giving that can't recognize once we've processed it, then y'all just call us and we'll be happy to give you status over the phone. And of course an EOB will always be mailed out to the provider as well.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, that sounds great well I appreciate all of your help.
[AGENT][POSITIVE] Oh, well, you're certainly very welcome. So is there anything else, uh, [PII], that I could help you with this morning?
[CUSTOMER][POSITIVE] No, that'll be it. I appreciate it.
[AGENT][POSITIVE] OK, well, you are certainly very welcome and thank you again for calling APL. I hope you have a wonderful day. Do you want me to transfer you to multi plan? Do you want me to transfer you to that number? Do you want to?
[CUSTOMER][POSITIVE] OK, you too. Thank you.
[CUSTOMER][NEUTRAL] I think I'm gonna pay for now.
[AGENT][NEUTRAL] OK. Well, all right then.
[CUSTOMER][NEUTRAL] Yeah, I've got the number on the back of the card, so I think I'm OK.
[AGENT][POSITIVE] Yeah. OK. All right. Well, then, again, thank you for calling APO and have a great day.
[CUSTOMER][POSITIVE] OK, you too. Thank you.
[AGENT][POSITIVE] Thank you, [PII]. Bye bye.