AccountId: 011433970860
ContactId: a31b603d-3857-4376-a204-b7fda0fa045a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642849 ms
Total Talk Time (AGENT): 156689 ms
Total Talk Time (CUSTOMER): 221911 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/a31b603d-3857-4376-a204-b7fda0fa045a_20250408T17:34_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] Hi Ms. [PII], this is [PII] from Benefits and a card.
[AGENT][NEUTRAL] Hi [PII], how are you today?
[CUSTOMER][NEUTRAL] Um, I'm OK. How are you?
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] I'm good. How can I help you?
[CUSTOMER][NEUTRAL] Um, so for some reason I have a provider's office on my line, um, stating that you that somebody from Ame APL told her that she has to, that we have to give you guys a call to verify coverage for a member.
[CUSTOMER][NEUTRAL] And I'm not sure um she's saying that we have to do that so that we can that way the the claim can be processed, but I mean I've never I've never had to call you guys for anything like that so I'm not sure what's going on.
[AGENT][NEUTRAL] So you have the insured or a provider on the line?
[CUSTOMER][NEUTRAL] A provider, she said she just spoke with somebody from APL and was told that benefits in a card has to give them a call to verify coverage for the claims to be processed.
[AGENT][NEUTRAL] Mm, OK. I don't know why they were told that.
[AGENT][NEUTRAL] Did she say who she spoke to? Yeah.
[CUSTOMER][NEUTRAL] Neither do I. I've never done that before.
[CUSTOMER][NEUTRAL] She didn't, um, and then she's like, and I explained to her that I can transfer over that that the process is not the way she's being told and she asked me to to give you guys a direct call to see what's going on so that's what I'm doing here.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. Now, what is the policy number she's calling about, [PII]?
[CUSTOMER][NEUTRAL] Um, I don't have a policy number. I have the the member's name and date of birth and the last four of the social if that works.
[AGENT][NEUTRAL] Now, if it's something that will, yeah, I mean, I can, what is the full social? Do, do you have the full social?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, so [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, [PII], and our disclaimer, any information provided would be a verification of benefits and not a guarantee of payment. So,
[AGENT][NEUTRAL] What is the, do you have the date, what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So it's two patients. It's [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Does she uh result in [PII].
[CUSTOMER][NEUTRAL] And then date of service is [PII].
[AGENT][NEUTRAL] For which one?
[CUSTOMER][NEUTRAL] For both.
[AGENT][NEUTRAL] OK, is
[AGENT][NEUTRAL] So the mother and the child have claims for the same date of service?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Well, uh, give me that date of.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], what is the date of service?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what's the bill amount for the mother?
[CUSTOMER][NEUTRAL] Oh, that I do not have. Um.
[CUSTOMER][NEUTRAL] Yeah, she did not tell me. Well, if you like, give me one moment, I can, I can take a look at that for me.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, because I would need to build them out, uh, let, let me just.
[AGENT][NEUTRAL] Let me look at something
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we don't even have a claim on file for that data service.
[AGENT][NEUTRAL] For the mother
[CUSTOMER][NEUTRAL] Give me one moment, let me confirm.
[AGENT][NEUTRAL] So I'm not maybe she.
[CUSTOMER][NEUTRAL] She said it was both
[AGENT][NEUTRAL] Maybe she needs to speak with IMA?
[AGENT][NEUTRAL] 5, and you said [PII] is the date of service? Because I see that the note, well, I don't, let me just look here because I don't see where she's spoken to anyone today here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or a provider
[AGENT][NEUTRAL] No, there's not any documentation since January of us speaking to the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] insured, not the provider. Now she's, she might be checking with IMA.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] But we don't even have a claim for either one of those part 1 or part 3 for.
[AGENT][NEUTRAL] For a [PII] period.
[CUSTOMER][NEUTRAL] Right, cause she
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm not sure.
[CUSTOMER][NEUTRAL] So she said she spoke with the American public. She said she spoke way as hell. Let me, let me confirm that date. I'm pretty sure that was the date, but let me confirm.
[AGENT][NEUTRAL] Yeah, who, and whose name? Yeah, and who's who did she speak with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, bear with me one moment.
[AGENT][NEUTRAL] Because we give our names. OK, thanks.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so now she's telling me that the the uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's two dependents with that data service 3425 it's [PII] and [PII] that we're seeing on that date and she doesn't know who she spoke with. She said she, it was just a couple of moments ago that she spoke with somebody.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, cause
[AGENT][NEUTRAL] OK, so the mother's not the patient.
[CUSTOMER][NEUTRAL] No, the patient is [PII] and [PII].
[CUSTOMER][NEUTRAL] Both dependents.
[AGENT][NEUTRAL] OK, so there's no claim on file for [PII]?
[AGENT][NEUTRAL] For that data service with us at all. Let me check the other.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And she did confirm it was [PII].
[CUSTOMER][NEUTRAL] Yep, [PII].
[AGENT][NEUTRAL] No, there's no claims on file for these dependents with us.
[CUSTOMER][NEUTRAL] OK, let me go ahead and let her know and get her through to you so that she can get those claims processed.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, give me one moment while I let her know that I'm gonna transferred to you.
[AGENT][NEUTRAL] And what is her name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] And her callback
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Number?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I can, uh, yeah, probably still try to see what callback number?
[CUSTOMER][NEUTRAL] See, I have her.
[CUSTOMER][NEUTRAL] Um, give me one moment. Let's.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, cleaning.
[CUSTOMER][NEUTRAL] Oh, I don't. I have to.
[CUSTOMER][NEUTRAL] Check that when I get back to her. Then then show me it only show you the APL number. Give me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alrighty, Ms. [PII], I have on the line with you.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, I have, um, Ms. [PII] on the line so you can she can assist you with those claims.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hey, um, this is [PII], and I just spoke with someone at your office, um, regarding to, uh, claims for these two dependents on the policy, and she told me that they have claims there, um, and that they're waiting benefit information from, um, benefits and a card. Um, I even have the EOBs from you guys.