AccountId: 011433970860
ContactId: 998398bc-f3fe-4efd-a531-d857ab1d1fab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 755150 ms
Total Talk Time (AGENT): 425359 ms
Total Talk Time (CUSTOMER): 262139 ms
Interruptions: 11
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/998398bc-f3fe-4efd-a531-d857ab1d1fab_20250228T17:59_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] Hello, my name is [PII]. I'm calling from provider office. I want to know about the claim status.
[AGENT][NEUTRAL] OK, your name is [PII], is that correct?
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] And you're needing claim status, [PII], is that also correct?
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The Direct line [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, 3 claims for the same member.
[AGENT][NEUTRAL] OK, 1 member for 3 days of service, is that correct?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] One patient for 3 different dates of service, is that correct?
[CUSTOMER][POSITIVE] Yes. Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], you will use my name that I gave you along with today's date as your call reference number?
[AGENT][NEUTRAL] Also any information.
[CUSTOMER][NEUTRAL] OK. What's your name?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] I see
[CUSTOMER][NEUTRAL] Last name initial?
[AGENT][NEUTRAL] Mhm. S and yours?
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][NEUTRAL] What is your last name initial, [PII]? You did not give that to me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and also any information that I provide for you today will be a verification of benefits and not a guarantee of payment and lastly [PII], if we do have the claims on file and you need a copy of the explanation of benefits, you may print them directly from our portal.
[AGENT][POSITIVE] And our portal website is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Patient policy number is D for 45400896.
[AGENT][NEUTRAL] What was the very first thing you said?
[CUSTOMER][NEUTRAL] D for David
[CUSTOMER][NEUTRAL] And 454-00896.
[AGENT][NEUTRAL] OK, so that is not a policy number for our company here at APL. The first letter was D as in Delta.
[CUSTOMER][NEUTRAL] Yes, uh, but I'm also see the name is ATC already mentioned on the member ID card and policy number is also mentioned in the same.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. The policy number would not have a D in front of it.
[CUSTOMER][NEUTRAL] Um, clearly see the member ID card policy started with a D and all the insurance name is ATC.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can see if this member also has a policy with my company, but I am not the company for the D number is 90 degree benefits, not American Public Life.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, could you search by the first name and last name?
[AGENT][NEUTRAL] What is the last name of your patient?
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] I'm sorry, what is the last name?
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] Spell the last name.
[CUSTOMER][NEUTRAL] PIN
[CUSTOMER][NEUTRAL] So, [PII]
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] It's still searching.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this a medical claim you're trying to check status for?
[CUSTOMER][NEUTRAL] Yes, yes, medical claim.
[AGENT][NEUTRAL] OK, so I may have located a policy. What is your first off, um, any information, as I stated before that I provide would be a verification of benefits and not a guarantee of payment? What is her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, so this is not that member, we do not have a member in our system with that name and that date of birth.
[AGENT][NEUTRAL] Now for 90 degree benefits their phone number, [PII], I can also transfer you.
[AGENT][NEUTRAL] But their phone number is [PII] option one.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. So would you like for me to connect you?
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] OK. Well, is there anything else I can help you with before I do that?
[CUSTOMER][NEUTRAL] No, no. That's all.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] 90 Degree Benefits. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hey, it's [PII] at APL. Happy Friday.
[CUSTOMER][POSITIVE] Happy Friday. Hallelujah.
[AGENT][POSITIVE] Yay. Now I'll just be happy [PII]. Oh, she hung up. Oh, well.
[CUSTOMER][NEUTRAL] Girl, me too, me too.
[AGENT][MIXED] Uh, it's been a very long week. Love my job, but it's been a long week this week.
[CUSTOMER][NEUTRAL] It has.
[CUSTOMER][NEUTRAL] It has, it really has.
[AGENT][NEUTRAL] Well, I had a provider on the line and I checked and the member she, the name she gave me, we did not have any matching information um.
[AGENT][NEUTRAL] And she was trying to check a claim status, but again, she hung up.
[CUSTOMER][NEUTRAL] Is it the one I just sent over there?
[AGENT][NEUTRAL] I don't know. Was it a lady by the name of [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, this is [PII], mm mm, for [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, yeah, yeah, yeah, yeah, yeah, that one too.
[AGENT][NEUTRAL] Oh, we didn't have a date that we had a, a policy for, not with the information that she gave me. I mean, the [PII] that we have, I located a [PII] that had an old policy like back in [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, she's got a policy with y'all.
[AGENT][NEGATIVE] But it didn't match the date of birth she gave me.
[CUSTOMER][NEUTRAL] Yeah, she had one then, but she also has one or had this one is also termed, but it was uh it termed in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the, no.
[CUSTOMER][NEUTRAL] So it was effective from [PII]. 0, I take that back. I take that back. There was a gap from [PII] [PII]. So it was actually.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] What's the, do, do you have the social cause I, I mean, I couldn't pull her up. What's the social that you have for this one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Yeah, because the one that I located, let me, let me look at that number.
[CUSTOMER][NEUTRAL] Yeah, I was the one that sent her over there because um.
[AGENT][NEUTRAL] So there's no one in our system with that social. [PII]?
[CUSTOMER][NEUTRAL] I show.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on just a second.
[CUSTOMER][NEUTRAL] I don't remember what she gave me. Let me go back.
[AGENT][NEUTRAL] Oh wait, here we go.
[AGENT][NEGATIVE] Yeah, that did not pull up for me.
[CUSTOMER][NEUTRAL] Oh yeah, she gave me the number.
[AGENT][NEUTRAL] Mhm. OK, well, maybe she will call back because I know, I just know.
[AGENT][NEGATIVE] That I cannot call this number and reach her.
[CUSTOMER][NEUTRAL] Absolutely. I, I, yeah, I never, I never tried to call them, those certain people back.
[AGENT][NEUTRAL] I will, I mean, I just,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right. I mean, right. OK, well, maybe she'll call back, but.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So what, how did you find the account that you did find?
[AGENT][NEUTRAL] By the name cause she had no other information.
[CUSTOMER][NEUTRAL] She didn't have the date of birth either.
[AGENT][NEUTRAL] No. Well, we can't search by date of birth. See, that's what I don't understand about these.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, it makes it very hard on I would say you and us.
[AGENT][NEUTRAL] When they only have these cards that have the D number but they have policies with us as well. I, I don't, I mean, I don't know how all that works.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and why they don't, but it's
[CUSTOMER][NEGATIVE] I don't understand why so many of them only have our our ID card.
[AGENT][NEUTRAL] Yeah, they never, you know, and so then we're.
[CUSTOMER][NEUTRAL] Like so many of them don't have your ID card.
[AGENT][NEUTRAL] Right, and then we're searching like a needle in a haystack.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Um, because we can't search by the member number.
[AGENT][NEUTRAL] And we can't search by that D number and so and they.
[CUSTOMER][NEUTRAL] Yeah, I didn't
[CUSTOMER][NEUTRAL] I didn't realize you couldn't do date of birth either though. That's, that's good to know. But yeah, that definitely limits you for sure.
[AGENT][NEUTRAL] Mm. No, we can't search my date of birth. Mm mm.
[AGENT][NEUTRAL] So the one that I had located.
[AGENT][NEUTRAL] The only one
[AGENT][NEUTRAL] Based on the information she gave me was didn't match the date of birth, so, and she did not tell me either.
[AGENT][NEUTRAL] But she had been transferred.
[CUSTOMER][NEUTRAL] Oh, that is a different person.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so the one that she's looking for's date of birth is [PII], yeah.
[CUSTOMER][POSITIVE] I didn't realize those were two different people, but you are right.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] But anyway she'll, I mean you know I tried to do the right thing so hopefully she'll call back again I just.
[CUSTOMER][NEUTRAL] Well, or she can get the right ID number, you know.
[AGENT][NEUTRAL] Right? That too, but, you know, the chances of that happening are much less likely than her just calling back.
[CUSTOMER][POSITIVE] Girl, you are so right. You're so right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sure she'll call me again and have me transfer even though I gave her your number before I transferred you. I'm sure she'll call me back.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, and she sure did not, she did not indicate any of that to me.
[CUSTOMER][NEUTRAL] Of course she didn't.
[AGENT][NEUTRAL] When I spoke with her, so that would have been helpful.
[CUSTOMER][NEUTRAL] Well, I told her when I transferred her, I was like they won't be able to use that ID number, um, but they should be able to locate her by name and date of birth.
[AGENT][NEUTRAL] Yeah, so just, you know, for your information, we cannot search date of birth.
[CUSTOMER][NEUTRAL] That is good to know. I did not know that.
[AGENT][NEUTRAL] We can't look at anyone, uh, any, mhm, yeah, if they don't have the policy number or the subscriber social, then we have to not even the patient, I mean, so like this lady happens to be the subscriber but that's the only social we can search for.
[CUSTOMER][NEUTRAL] Social.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So if it's a dependent and they give us a dependent social then we can't, you know, even if it's in the system because some of them do have dependent social it still won't pull.
[CUSTOMER][NEUTRAL] Well, I mean, that makes sense. That's the only.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] From the dependent social. So anyway.
[CUSTOMER][NEUTRAL] Yeah, we can't use the defendant social either. We have to have the policy holder.
[AGENT][POSITIVE] That's why it's, you know, why it's so much better.
[CUSTOMER][NEUTRAL] But we can search by date of birth, so that, that makes us.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Makes it a little bit easier for us than y'all, I guess.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah. So if we get somebody looking for a [PII] with no other information.
[CUSTOMER][NEUTRAL] All right, girl.
[AGENT][NEUTRAL] We might be here till [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You better go find the right ID number and call me back.
[AGENT][POSITIVE] Right, right, right, right. But we try to help them if we can, so, you know, but anyway, well, girl, it was good talking to you and if I don't talk to you again today, have a great weekend. Usually, when I say that, you and I'll talk about 5 more times, but in case we don't.
[CUSTOMER][NEUTRAL] Uh, yeah, I know you do.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] I know, you just jinxed us.
[AGENT][POSITIVE] Right. In case we don't, I hope you have a great weekend, [PII].
[CUSTOMER][POSITIVE] You too, girl. Thank you.
[AGENT][POSITIVE] All right, thanks. OK.
[CUSTOMER][POSITIVE] All right. You're welcome. Bye.
[AGENT][NEUTRAL] Bye-bye.