AccountId: 011433970860
ContactId: a9068dda-2ed1-4b29-8d0d-ac0e269d7aad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522900 ms
Total Talk Time (AGENT): 233343 ms
Total Talk Time (CUSTOMER): 84584 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/a9068dda-2ed1-4b29-8d0d-ac0e269d7aad_20250131T13:40_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] Hi [PII]. My name is [PII] and I need some help with a claim, please.
[AGENT][NEUTRAL] OK, [PII]. What, you said you're needing help with a claim?
[AGENT][NEUTRAL] What do you mean by that?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I need to know if you have it and if it is uh processed.
[AGENT][NEUTRAL] OK, so you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, ma'am. I can help you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] That is D 245-5919.
[AGENT][NEUTRAL] OK, now, thank you, [PII], but that is not the policy number for American Public Life. That is a 90 degree benefit number.
[CUSTOMER][NEUTRAL] OK, let me pull her card just to.
[AGENT][NEUTRAL] Were you trying, OK, sure.
[AGENT][NEUTRAL] Some of the members that have those types of policies also have an APO policy, but there would be a different number for us.
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Do you have, is your patient a subscriber on the policy, [PII]?
[CUSTOMER][NEUTRAL] Yes, she is.
[AGENT][NEUTRAL] Do you have her full social?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Alright, one moment. I'll try and look it up by that.
[AGENT][NEUTRAL] To see if the member has a policy with us. OK, what is that number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what type of plan are you calling on? Is this for medical?
[CUSTOMER][NEUTRAL] Yes, it's medical.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I believe I may have located a policy and any information, [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII], birthday is [PII].
[AGENT][POSITIVE] All right. Thank you. So give me just a couple of moments, please.
[AGENT][NEUTRAL] OK, so I have located a policy for her. The policy number that you should have for APL is 02455919.
[CUSTOMER][NEUTRAL] OK, that's the policy number.
[AGENT][NEUTRAL] Yes, ma'am, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is your date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] [PII] charges are $940.95.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so this claim was received on 1-29-2025.
[AGENT][NEUTRAL] Actually, let's go back. Let me change that. I'm so sorry. [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And actually, that's not gonna be correct either. I'm so sorry. Give me just a moment. Let me refresh one of my screens, please, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] I don't mean to give you the wrong claim number, so one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so actually this claim was received on 9-17-2024.
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 9263.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII] states that benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEGATIVE] No amount payable under this expense.
[AGENT][NEUTRAL] Mhm. Under this policy. This is not a major medical policy. This is a limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we receive an explanation of benefits that indicates that?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes ma'am, I, you can actually print it directly from our portal by going to [PII].
[AGENT][NEUTRAL] And you can set up a profile to print it from there, but I will go ahead and see if I can fax this one to you if I'm able to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I may not be able to fax it at the moment. Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] I will certainly try.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you get that website that I gave you, or do you want me to say that again?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] Perfect. OK. And does the fax need to be sent to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] No, you can just, um, attention HRS that's our company and the fax number is 812.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and I'm gonna repeat that back. [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK. Well, I have just faxed that to you so provided that there's not any issue with it being received, you should be receiving that uh very shortly.
[CUSTOMER][POSITIVE] All right, thanks for your help and time today.
[AGENT][POSITIVE] Oh, you're very welcome. Is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Not at this time. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a great uh weekend.
[CUSTOMER][POSITIVE] You as well. Thanks. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.