AccountId: 011433970860
ContactId: a449a632-4d63-468b-bf9a-36a6303a9e70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 559710 ms
Total Talk Time (AGENT): 241359 ms
Total Talk Time (CUSTOMER): 136058 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/a449a632-4d63-468b-bf9a-36a6303a9e70_20250228T17:39_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] Of all I don't know like this is a.
[CUSTOMER][NEUTRAL] Hey, I'm calling from a provider's office to check claim status.
[AGENT][NEUTRAL] OK, you have one patient that you're needing claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] D as in David.
[CUSTOMER][NEUTRAL] 43510921
[AGENT][NEUTRAL] OK, thank you, [PII], but that is not the an APL policy number, that is for 90 degree benefits. Were you trying, do you know if the member also has a policy with APL?
[AGENT][NEUTRAL] Or were you trying to reach 90 degree benefit?
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the insurance card shows, um sorry, let me pull it up real quick.
[AGENT][NEUTRAL] Mhm, certainly.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] There should be another number on their ID card, besides the D number.
[CUSTOMER][NEUTRAL] So the insurance card.
[CUSTOMER][NEUTRAL] OK, says employee ID is the D number employee name, group number. So on the back it says medical claims submission. It shows the payer ID and says mail to benefits in a card, and then it also has the 90 degree little symbol.
[AGENT][NEUTRAL] OK, now before I connect you to 90 degree benefits, [PII], some of these members also have policies with APL as well. I can try and search to verify that we whether we do or do not have a policy for this number before I transfer you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so do you happen to have the member's full social?
[AGENT][NEUTRAL] If not, I can try by the name. If it's a very common name, I don't know without more information if I'll be able to locate it, but I'll try. What's the last name?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[AGENT][NEUTRAL] Mhm. First name?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me see what I can locate.
[AGENT][NEUTRAL] And while this is searching, [PII], did you call [PII]?
[CUSTOMER][NEUTRAL] No, I called. It's [PII]. That's the only that's what it says on my insurance card says call 90 degree benefits at the [PII] for email.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so for you that is the correct number for 90 degree benefits. It's option one. When you call that number depending on the option that you choose as to where it will take you, and I believe that one of the options, you know, I mean it is for APL also, but give me.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so I may have also located a policy for this person with APL as well, and any information [PII] that I do provide would be a very a verification of benefits and not a guarantee of payment. What is the patient's date of birth?
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I have located a policy in which he is a dependent on.
[AGENT][NEUTRAL] And the policy number for APL is 02573800.
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[AGENT][NEUTRAL] Give me just one moment to get the rest of the information pulled up, please.
[AGENT][NEUTRAL] And what is the date of service [PII] and total bill amount for him?
[CUSTOMER][NEUTRAL] Uh [PII] $1940.15.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so give me just a moment. I going to look at something that we just received. I don't know if this is the claim you're looking for, uh, it is not yet in process. We just received it on yesterday, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so no ma'am, we do not have a claim. We have not received a claim for that bill amount for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Now once you all do file the claim and it has been processed through APL, we do have a portal, [PII], that you should be able to check our claim status in and also have access to our EOB and our portal website for that is secured. [PII].
[CUSTOMER][POSITIVE] Yes, yep, I, um, I do have access to that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so for these claims, does it need to go to 90 degrees? Does it need to go to APL or benefits?
[AGENT][NEUTRAL] Yes, because it will, it would get, no, it's going to go to IMA it goes through their clearing house, so you would send the claims to IMA.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And their payer ID is 64556.
[CUSTOMER][NEUTRAL] The zip code you said [PII]?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, so [PII] is the payer?
[AGENT][NEUTRAL] That is where the claims will be sent to, yes, and that is their payer ID mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I. I OK.
[CUSTOMER][NEUTRAL] OK dokey.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said you were with um APL's American Public Life.
[AGENT][POSITIVE] A Yes, ma'am. Public life. That's correct. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. Can I get your name and a reference number, please?
[AGENT][NEUTRAL] My name and today's date will be your call reference number and again my name is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Alright, well, you're very welcome. So if that's all I can help you with today, [PII], thank you again for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.