AccountId: 011433970860
ContactId: 9f0b92b9-fa43-4b3f-9848-41c3fad0c9df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346839 ms
Total Talk Time (AGENT): 168649 ms
Total Talk Time (CUSTOMER): 100139 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/9f0b92b9-fa43-4b3f-9848-41c3fad0c9df_20250123T16:29_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] Yes, Ms. [PII], my name is [PII]. I'm calling from a provider's office to verify eligibility for a patient of ours, please.
[AGENT][NEUTRAL] OK, so do you're needing to verify eligibility? Do you also need benefits or just eligibility?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, just eligibility would be OK.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with that. And [PII], what is um your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Absolutely, it is 02481768.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] Thank you very much. So one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on this policy.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], once the claim has been processed, we do have a portal in which you should be able to access the status of that claim and also the EOB.
[AGENT][POSITIVE] And our portal website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, I've gotten a letter um we sent in a claim and I've got a letter back that stated that the insured was not found.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hm, so that is the correct ID number?
[AGENT][NEUTRAL] Uh, yes, ma'am. I mean for this limited benefit plan, that is correct. And who is the letter from?
[CUSTOMER][NEUTRAL] Uh, IMA incorporated.
[AGENT][NEUTRAL] OK, so, um, let me, IMA is where the claims are mailed to?
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's for $165.
[CUSTOMER][NEUTRAL] It says uh the above claim was recently submitted to us unfortunately we are unable to process the claim due to the reasons listed below insured not found in BIC membership file.
[AGENT][NEGATIVE] OK, um, I can't speak to that unfortunately, um, we haven't received.
[AGENT][NEUTRAL] It's not been forwarded to us. I don't know if maybe there was an, is that the number? Did they reference the policy number?
[AGENT][NEUTRAL] On the ladder.
[CUSTOMER][NEUTRAL] They did, mhm, they did, mhm.
[AGENT][NEUTRAL] OK. All right. So then if they're
[AGENT][NEUTRAL] As of now, we show that she's on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, effective [PII] benefits in a car to the enrollment company for her husband's employer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and we do receive electronic files, so I don't know if maybe I, I, I can't speak to that on IMA.
[CUSTOMER][NEUTRAL] OK, um, so it does it that's where it needs to go, is that correct?
[AGENT][POSITIVE] That is correct. That is correct, yes, ma'am. What address do you have for them?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And let's see um.
[AGENT][NEGATIVE] [PII]. That's not correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's IMA and the [PII] you had [PII] is correct.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a payer ID of 64556.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, well I shall send it back. Thank you so much for your help today, [PII]. Is there a reference number for our call?
[AGENT][NEUTRAL] Well, you sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help today.
[AGENT][POSITIVE] Well, you are certainly very welcome and is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Um, not that I know of, but thank you so much.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again, [PII] for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You do the same thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh-huh, bye bye.
[AGENT][NEUTRAL] Bye-bye.