AccountId: 011433970860
ContactId: 92bac196-199b-4841-9391-ed196fa1197e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694929 ms
Total Talk Time (AGENT): 356244 ms
Total Talk Time (CUSTOMER): 233657 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/92bac196-199b-4841-9391-ed196fa1197e_20250117T18:48_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm trying to uh verify the benefits for a member.
[AGENT][NEUTRAL] OK, you're needing benefits only or do you also need eligibility?
[CUSTOMER][NEUTRAL] Yeah, eligibility. I just need to get like if I, I gotta have a claim that's denied saying that she's not an eligible dependent, so I just need to see if she's actually on the policy if the policy is active.
[AGENT][POSITIVE] Sure. Yes, ma'am. I can help you with all of that. And who am I speaking with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] D as in dog 476-885-49
[AGENT][NEUTRAL] OK. Now, [PII], that, thank you, but that is not a policy number for APL. That is a 90 degree benefit policy number. Were you trying to reach 90 degree benefits or?
[AGENT][NEUTRAL] Do they also have a policy with us?
[CUSTOMER][NEUTRAL] Yeah, I mean, I, I
[CUSTOMER][NEUTRAL] No, that's the number that's on the back of the card that I called.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] No, and that's not what you want on my phone either [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Yes, ma'am, you just selected um another option on that number, the number option you need is if it's for a 90 degree benefit policy only is option one. But I would be very happy, [PII], to transfer you to them if you would like. And again, hopefully, nothing would happen, but if it does, same number, just option one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] All right, cool.
[CUSTOMER][POSITIVE] All right sounds good thanks for your help.
[AGENT][POSITIVE] Absolutely, you're very welcome. So thank you again for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thanks a lot you too.
[AGENT][NEUTRAL] Yes, ma'am. One moment.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card members. Please select from the following options to ensure you are directed to the appropriate party to answer your questions.
[CUSTOMER][NEUTRAL] 90 Degree Benefits. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Why it's [PII] again.
[CUSTOMER][NEUTRAL] Hey girl.
[AGENT][NEGATIVE] OK. So I have another provider that did the same thing as earlier. She says that they do not have a policy with APL and she was trying to reach 90 degree benefits. She just selected the wrong option.
[CUSTOMER][NEUTRAL] Mm, that other one did. I had to transfer her back because it was um.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] They had APL and uh our Mac plan, but uh, yeah, it was a medical claim they were looking for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yup. Well, she says that the only um
[AGENT][NEUTRAL] The only number that she has on the card is this number and she was trying to reach 90 degree benefits, so.
[AGENT][NEUTRAL] I didn't try to delve in.
[CUSTOMER][NEUTRAL] Well, that's probably because APL card it's a different card, a separate card, but uh do you have a good callback number?
[AGENT][NEUTRAL] Yeah, it is [PII], and this lady's name is [PII].
[CUSTOMER][POSITIVE] I see. All right, thank you, ma'am.
[AGENT][NEUTRAL] Mhm. You are certainly, I tell you what, let me just go ahead. I did, she did give me the number for you all. Um, I think I got this right. D 476-885-49.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] She didn't give me her name, but I mean, does she have a, can you see, so we can't see if they have policies with you.
[CUSTOMER][NEUTRAL] Oh, yes, yeah, she does have both.
[CUSTOMER][NEUTRAL] Yeah, she's got the VIP standard.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, let me get back on the line with her and verify exactly so that you don't have to do that again. I mean.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Again, when they tell me that they don't have but one because I do explain that some of these members have dual coverage, and she's like, no, because she says she's received a denial for a dependent that was stated that was not covered under the plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, well.
[AGENT][NEUTRAL] So I don't know.
[CUSTOMER][NEUTRAL] Yeah, cause, well, no, it's not um it don't matter. If you want me to try first, I will and then just send her back if, if I don't have it.
[AGENT][NEUTRAL] Oh, that's OK. I already have her on the, I mean, I have her on the line. So, um, let me see if I can just locate it because she don't have a policy number for APL. She has none of that.
[CUSTOMER][NEUTRAL] Yeah, but I don't know why nobody they they never have or give them the APL ID card, so they just assumed that our card is for everything.
[AGENT][NEUTRAL] I I can't, you know, and then on our ID cards, it has the member ID number. So they try to give us that anyway. Mhm. Well, let me see if I can try and help her and if not, I'll, yep, let me do that then. What's the name again?
[CUSTOMER][NEUTRAL] Yeah, right, exactly. Yeah. All right, well just send her back if you don't find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What was her name again? Uh-huh.
[CUSTOMER][NEUTRAL] Uh, Brittany, B R I T T A [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. uh, let me, yeah, let me work with her for a couple more minutes first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, [PII]. Thank you.
[CUSTOMER][POSITIVE] You're welcome. Have a good one. All right. Thank you. Bye.
[AGENT][NEUTRAL] Alright, you too, bye bye.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hi [PII], this is still [PII]. Hey, [PII], this is still [PII] with APL. So when I was transferring you, they told me that this member does have dual coverage. So let me, instead of me transferring you over there and then having to have them transfer you back over here, let me see if we have anything in our system first and not then I'll transfer you. So do you have any other information, a full social for the subscriber?
[CUSTOMER][NEGATIVE] Tiny luck getting on 90 degree bit.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I do for the subscriber yeah not the claim that I have is for the child and it's saying she's not eligible dependent, but I do have um the members.
[AGENT][NEUTRAL] Anything else
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But I need the, mhm.
[AGENT][NEUTRAL] All right. Give me that full social so I can see if I can locate the policy that they.
[CUSTOMER][POSITIVE] Yeah, I got her social right here.
[AGENT][NEUTRAL] That at least the subscriber has with us.
[CUSTOMER][NEUTRAL] OK, cool, it's um her social is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. One moment.
[AGENT][NEUTRAL] I'm just trying to save you a transfer.
[CUSTOMER][POSITIVE] Yeah, that sounds good to me.
[AGENT][NEUTRAL] Alright, and any information that I do provide for you today would be a verification of benefits and not a guarantee of uh payment. What is the patient's name and date of birth? Or let's do this first. Do you have the subscriber's name so I can verify that.
[AGENT][NEUTRAL] I'm indeed looking at the correct policy.
[CUSTOMER][NEUTRAL] Yep, her name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You want her date of birth? It is uh [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the dependent that you're calling on behalf of?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[CUSTOMER][NEUTRAL] It's spelled kind of weird. It's [PII] and then her date of birth is [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I can tell you that.
[AGENT][NEUTRAL] We do, our records do not indicate that there is a dependent child on that, on this policy with that name.
[CUSTOMER][NEUTRAL] OK, so she probably just never added this child to that policy.
[CUSTOMER][NEUTRAL] Because yeah I was looking at her card and it says um employees and children like on her medical coverage and I'm like well this is a kid so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEGATIVE] So she must have just never added this kit to the policy.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEGATIVE] Yes, as of right now, this, this child is not showing on this coverage.
[CUSTOMER][NEUTRAL] OK, I will try to um give this member a call and see if she can call in and find out what she needs to do or contact her HR department and then I would just get a note in her claims here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, she's.
[AGENT][NEUTRAL] Yeah, she would just actually need to contact, let me look for this group one more time.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Yes, if
[AGENT][NEUTRAL] She would actually need to speak to Benefits and a card, which is the enrollment company for her employer, or they also go by BIC like the brand of pins.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that phone number for them is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I will attempt to give her a call.
[AGENT][NEUTRAL] And what is the data service that you have for [PII]?
[CUSTOMER][NEUTRAL] Um, it is, uh, the first one is [PII], and then she was just there again on [PII].
[AGENT][NEUTRAL] What's the bill amount on the first claim?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] Our data service rather, I'm sorry.
[CUSTOMER][NEGATIVE] Whoops, my screen just flipped. Oh man, we've been having so many computer issues. It's been crazy the last couple of days. I know it's making everything go, um, $130 on the [PII] dollars visit.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And the other one?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] On [PII] and it was $298.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One more thing.
[AGENT][NEUTRAL] And what you received, does it have, is it from American Public Life?
[CUSTOMER][NEUTRAL] Um, the letter came from Smart Data Solutions and it says I am IMA incorporated.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] OK, so yes, because that's where the claims on this policy are sent to, but um, OK, so yes ma'am, I would reach out to her and then, you know, you can give her that phone number that I gave you, [PII], if she has any, you know, questions about enrollments.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or who should be enrolled on her policy.
[CUSTOMER][POSITIVE] Alright, that sounds good. I will give her a call and see if I can pass this information along. I appreciate your help so much, [PII].
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, well, you are certainly very welcome and again, it was nice speaking with you and I hope you have a great weekend.
[CUSTOMER][POSITIVE] You as well thank you so much.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.