AccountId: 011433970860
ContactId: 98cdf524-81ed-4b7d-89ac-5e77e8b3bd83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450100 ms
Total Talk Time (AGENT): 157360 ms
Total Talk Time (CUSTOMER): 267314 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/98cdf524-81ed-4b7d-89ac-5e77e8b3bd83_20250411T19:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I have like a dumb question. I'm calling from Nicholas Children's Hospital. Um, I've, I called to verify benefits on [PII], but this is APL in my system. I have Prosperity Life Group, so I'm kind of confused. Like I wanna make sure I spoke to you guys to verify the benefits on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, I can look at the notes.
[CUSTOMER][NEUTRAL] Do you have record of all that information? OK, but the only thing I have, I have, uh, the only thing I have like the reference name was [PII], that's all I remember.
[CUSTOMER][NEUTRAL] I don't know and it was on 42 that I called.
[AGENT][NEUTRAL] I mean, I can check for you. There's no [PII] in our department, but there is an [PII] in customer service, but I could check for you.
[CUSTOMER][NEUTRAL] So then uh
[CUSTOMER][NEUTRAL] So I'm lost and but and I was told that the patient has $6500 available for outpatient services. So if it wasn't you guys then it was really prosperity because in the system I have Prosperity Life Group, but in front of me I have a card that says APL, so I don't know if they're still active with APL or if they're active with Prosperity Life Group.
[AGENT][NEUTRAL] OK. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is, sure, sure. My name is [PII]
[CUSTOMER][NEUTRAL] I didn't see even a payer ID. I think that I'm wrong, OK, and my callback number is [PII].
[CUSTOMER][NEGATIVE] Maybe they used to have IPL and maybe they don't have it anymore. I don't know because I even have a payer ID number.
[AGENT][NEUTRAL] OK, and on the card, what's the member the um policy er number?
[CUSTOMER][NEUTRAL] 02611449.
[CUSTOMER][NEUTRAL] Because on my notes nothing matches this card so that's something and maybe this is an old card that was in the system.
[AGENT][NEUTRAL] And it was 02611449?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. What's the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] If you say they're not active I'll be happy because that means I'm that means it is the other company.
[CUSTOMER][NEGATIVE] Because even the payer ID number I have on my notes doesn't match the payer ID on this card.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Alright, so there's a few things. So all the information provided is a verification of benefits, not a guarantee of payment. So the policy is active as of [PII], but there are no notes on here from [PII], um showing that you spoke with us and
[CUSTOMER][NEUTRAL] Mhm mhm mhm.
[CUSTOMER][NEGATIVE] But and then because I called and they told me the patient had $6500 available for our patient services. That doesn't make sense. Does it show that?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][POSITIVE] Then maybe it is prosperity.
[CUSTOMER][NEUTRAL] I just don't have a card.
[AGENT][NEUTRAL] Is that inpatient and outpatient? Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I will co-pay cut off.
[AGENT][NEUTRAL] Uh, OK, so yeah, $6500 is the max for the outpatient benefits.
[CUSTOMER][NEUTRAL] And that's what I told they had a I was told they have that amount available.
[AGENT][NEUTRAL] Let me see if he's using.
[CUSTOMER][NEUTRAL] I because I wrote down 4 that I even they even told me the policy became effective 43.
[CUSTOMER][NEUTRAL] But see that's not the policy number I have in the system.
[AGENT][NEUTRAL] I mean, so.
[CUSTOMER][NEGATIVE] I'm confused.
[AGENT][NEUTRAL] So he, OK, so this insurance policy that they have with us is a secondary insurance. It's second only to United Healthcare though, so that other insurance, I don't know.
[CUSTOMER][POSITIVE] Mhm, right, yes, right, right, absolutely, absolutely.
[CUSTOMER][NEUTRAL] So maybe they have another one because.
[CUSTOMER][NEUTRAL] I, I, and I have payer ID number. I don't know, maybe I, I have the pay ID number as 89486, but then the card says 60801.
[AGENT][NEUTRAL] 60801 is is American Public Life's payer ID.
[CUSTOMER][NEUTRAL] Right, so, but then you're saying they do have $6500 available for outpatient services.
[AGENT][NEUTRAL] Right, I'm agreeing with you. All of this information is correct for APL for the other insurance, I don't know.
[CUSTOMER][NEUTRAL] Yeah, but why wrote down [PII]?
[CUSTOMER][NEUTRAL] Uh, this is weird. Why do I have [PII]? I have a name written down [PII].
[CUSTOMER][NEGATIVE] You said but there's no call, no nothing showing that I that that I called.
[AGENT][NEUTRAL] Right, um, I mean, they could have 3 insurances if they have UnitedHealthcare, a second, I mean, it could be a spouse or someone that has another.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Yeah, they might have also prosperity, yeah, because, yeah, because I'm, I have an APL card in front of me, but what I have written down says payer ID 89486 policy became effective [PII] all available and I have a name right now, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so it might be a mix of both, but.
[CUSTOMER][NEUTRAL] Or [PII], would it be I don't know if I have [PII]. I have let's see [PII] and I have [PII]. Only [PII] Almighty knows in heaven. OK, so but the APL policy is active and if you can't, did it come active last year?
[AGENT][NEUTRAL] Mhm. [PII] of this year.
[CUSTOMER][NEUTRAL] I don't have that. I have [PII] of last year, OK.
[CUSTOMER][NEUTRAL] Um, hm hm hm hm hmm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we became active [PII].
[AGENT][NEUTRAL] Wait a minute, [PII] of last year?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's what I have written on piece of paper.
[AGENT][NEUTRAL] So that may be the prosperity because there was a, there was a lapse here from [PII] to [PII]. So maybe they did have them in between.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So may OK but yeah because I even have a different policy number. I have a different phone number everything says Prosperity Life Group, so I'm gonna call them back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm gonna call them so but they are active with APL as well.
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] Mm, and they would also have this uh still 6500 even all well no they got a lot of coverage. OK, I'm gonna also call Prosperity though, but they are active, so the and the name [PII] and [PII], not those names don't make sense to you.
[AGENT][NEUTRAL] And they do have the 6500.
[AGENT][NEUTRAL] I mean, we did have a representative named [PII], but she retired a few years ago, maybe a year ago, and then [PII] is in a different position, a different department, like she's customer service, but
[CUSTOMER][NEGATIVE] OK, maybe something wrong with me, mhm.
[CUSTOMER][NEUTRAL] So maybe uh huh.
[AGENT][NEUTRAL] I just don't see any notes here from other than other than um [PII], but it wasn't a call.
[CUSTOMER][NEUTRAL] It's weird, right?
[CUSTOMER][NEUTRAL] OK, so, but I can also, but I can still, I can say that this APO act this APL is active as of [PII] you said?
[AGENT][NEUTRAL] Yes, ma'am, of [PII].
[CUSTOMER][NEUTRAL] OK, well, A, so alright, so as of [PII], this policy is active, um, and the payer ID is 60801 and the policy number I gave you was good 602611449. OK, um, I guess, OK, I guess I'll get a reference number for this call then, and I'm still gonna call Prosperity though. OK, um, what's the reference? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, that's that'll be all.
[AGENT][POSITIVE] All right, well, thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] OK thank you thank you you too.
[AGENT][NEUTRAL] Bye bye.