AccountId: 011433970860
ContactId: 8b5c0c7c-89e6-44aa-b10c-24926f2f9461
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471609 ms
Total Talk Time (AGENT): 162033 ms
Total Talk Time (CUSTOMER): 212812 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/8b5c0c7c-89e6-44aa-b10c-24926f2f9461_20250304T14:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good morning. My name is [PII] from provider's office, and this call is regarding the claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. The phone number is [PII]. It's a direct line.
[AGENT][NEUTRAL] All right, may I have the member's policy number? I'm sorry.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Yes, I'm sorry, I'm sorry for that. It's uh D as in Delta.
[AGENT][NEUTRAL] Oh no, you're OK.
[CUSTOMER][NEUTRAL] 403-10465.
[AGENT][NEUTRAL] And do you have the member's ID card available?
[CUSTOMER][POSITIVE] Yes, I got that one.
[AGENT][NEUTRAL] And on the card, do you see anywhere that says inpatient or outpatient policy cert number?
[CUSTOMER][NEUTRAL] I have the group number only.
[AGENT][NEUTRAL] OK, what's the group number?
[CUSTOMER][NEUTRAL] 90 sorry, 9403.
[AGENT][NEUTRAL] Do you see anywhere that says policy cert number?
[CUSTOMER][NEUTRAL] Yes, that starts with D as in Delta.
[CUSTOMER][NEUTRAL] 403-10465.
[AGENT][NEUTRAL] OK, um, so that the number is for 90 degree benefits, um, to the top left corner of the card, do you see APL?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Not, uh, what is that APL? I don't have the APL.
[AGENT][NEUTRAL] APL, this is, this is the company that you're calling. This is APL. What phone number did you dial? Was it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, no, initially I called to the which insurance, initially I called to the 90 degree benefits. They said that it was processed by the APL, that that's what it was pricing by the APL that is American Public Life, so they transferred to you. I want to know whether patient plans has the medical. Mhm.
[AGENT][NEUTRAL] OK, what's the
[AGENT][NEUTRAL] What's the members do you have the member's social security number?
[CUSTOMER][NEUTRAL] Just a moment. Yes, I have that one.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 499564
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Because I checked out in the ID card, because I checked out in the 90 degree benefits portal. It doesn't show the member is active or not. That's what I made the call with you.
[AGENT][NEUTRAL] So you want, you want to know if the policy is active or not?
[CUSTOMER][NEUTRAL] Yes, yes, because we submitted the claim to you on [PII].
[CUSTOMER][NEUTRAL] And whether you received the claim or not.
[CUSTOMER][NEUTRAL] And what's the payer ID? May I know the effective date?
[AGENT][NEUTRAL] OK, hold on, let me find the policy first. Um, and this is for their medical policy?
[CUSTOMER][POSITIVE] Oh, OK. Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yes. Do you need the tax ID?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] No, sir. I, I'm locating the policy so that we can, I can get you the information you need.
[CUSTOMER][NEUTRAL] OK, OK, fine. And your name is [PII]
[AGENT][NEUTRAL] Yes, that's correct. First initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII] and date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And hold on.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So the policy number is 258.
[AGENT][NEUTRAL] 5325.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Here you.
[AGENT][NEUTRAL] The policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service for your claim?
[CUSTOMER][NEUTRAL] Our data services.
[CUSTOMER][NEUTRAL] What is that? [PII]. And the policy number is 2585325.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] But in the ID code, they mentioned D as in Delta 40310465?
[AGENT][NEUTRAL] Right, as I stated, that's for 90-degree benefits. This is American Public Life, that's it's two different companies.
[AGENT][NEUTRAL] So that policy number that you have is for 90-degree benefits and the one that I provided is for APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for which, uh, OK, for which number I I should use for the client.
[AGENT][NEUTRAL] The APL policy number.
[CUSTOMER][NEUTRAL] Because the instruments by then.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] Because it's coming to APL.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, the pricing by the APL, so we should we should use follow the APL.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] OK, so for your claim status,
[CUSTOMER][NEUTRAL] So we do have
[AGENT][NEUTRAL] There's no claim on file for data service [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what's your payer ID?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] It's uh in the ID code they mentioned 64.
[AGENT][NEUTRAL] 64
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 645-56
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, that is your mailing address is Benefits in your card [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, but it's not going to benefit in a car that's going to IMA like Igloo, Mary, Alpha.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, fine, fine. OK. 64556.
[AGENT][NEUTRAL] But that's the correct address.
[CUSTOMER][NEUTRAL] Oh yes, I am a big line of business. OK, OK. It's showing in my payer ID. OK, fine. And the current member ID is 2585325 and the time frame for the insurance is 180 days from the date of service.
[AGENT][NEUTRAL] Wait a minute, say that one more time.
[CUSTOMER][NEUTRAL] And what is the time for failing to build the insurance?
[AGENT][NEUTRAL] There is no timely filing limit as long as the policy was active on the data service.
[CUSTOMER][NEGATIVE] OK. No timely feeling at all to build the insurance.
[AGENT][NEUTRAL] Right, 180 days um from the denial date for APL is for an appeal.
[CUSTOMER][NEUTRAL] OK, fine. And the appealing mailing address is the same. I'm sorry, the pay ID is the same and the mailing address for an appeal.
[AGENT][NEUTRAL] Is the the mailing address in [PII].
[CUSTOMER][NEUTRAL] Oh, that's the same address [PII]. OK, fine. And could you and your name is I got that one and may I know the call reference number for this patient.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] And your name is [PII] OK, fine, [PII], thank you. And today's date is [PII]. Perfect. Thank you. Thank you for assistance. Have a wonderful day. Enjoy the rest of your day. Bye for now. Thank you. Once again, bye-bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Bye bye, thank you.