AccountId: 011433970860
ContactId: bab670dc-cfb6-4004-80da-37a40647fa8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584989 ms
Total Talk Time (AGENT): 183383 ms
Total Talk Time (CUSTOMER): 278329 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/bab670dc-cfb6-4004-80da-37a40647fa8f_20250131T17:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, excuse me, I'm calling from a provider's office and one of our patients' claims was paid, um, originally by web TPA, but then the check was stopped and I guess sent to you guys because it's a larger amount and had to be verified from you first.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm just calling to follow up on that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, I can check and see if it, if we have that or if you need to get with CPA. Um, may I have your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Of course [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And let's see, what's the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Of course, that is 02277644.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me check the notes really quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I don't see anything regarding it and it was, you said it was a um claim that was paid?
[CUSTOMER][NEUTRAL] Yeah, it was uh we so we received a check from Web TPA for $20,000 and then the following day it was returned stating that it was a stop payment and when I called Web TBA before I called you, they stated that was because it was reissued to American Public Life on [PII] of this month.
[CUSTOMER][NEUTRAL] Due to the large amount has to be approved.
[AGENT][NEUTRAL] OK. And Ms. [PII], you're calling from a provider's office or you're calling from, um, where are you calling from exactly?
[CUSTOMER][NEUTRAL] I'm calling from a provider's office from Connama Memorial Medical Center, yes.
[AGENT][NEUTRAL] Provider.
[AGENT][NEUTRAL] OK, so, um.
[AGENT][NEUTRAL] Uh, I'm gonna go ahead and get Web TP on the line. The reason I'm gonna get them on the line is because if, um, everything went through correctly, they know that the claim was processed and it was sent again because what we do is we approve and send it back to them and we don't do anything in our system with the check because we don't process those claims so they they are processed by web TPA OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so she will be able to let you know if it was approved, if it was reissued again, if it went out again, OK?
[CUSTOMER][NEUTRAL] OK. So it's
[CUSTOMER][NEUTRAL] OK, so essentially they should have already sent it to you, got approval, and sent us the check, is that what you're saying?
[AGENT][NEUTRAL] Correct, the only thing we do here is we approve it and we send it back to them so they can go ahead and send it out to the provider.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So we just approved the amount. That's what we do. Mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][NEUTRAL] Yes, and yeah, and I don't see here um that information because that's handle in the back um that's gonna be customer service with a web TPA and Universal Trucking all together working together so yeah it's it's just a little bit different so but yeah the ones that can give you better information is web TPA. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's OK.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account such as an address change, add or drop a dependent, or wish to modify your coverage in any way, please call American Public Life at [PII]. If you are a physician or hospital calling to verify medical eligibility, please press 1. For information and phone numbers for the Beach Street PPO network, please press 2.
[CUSTOMER][NEUTRAL] For questions concerning pharmacy services, you may contact Caremark at [PII]. To speak to a customer service representative regarding any other issues, please press 3 now or simply stay on the line and someone will assist you. Thank you.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account such as an address change, add or drop a dependent, or wish to modify your coverage in any way, please call American Public Life at [PII]. If you are a physician or hospital calling to verify medical eligibility, please press 1. For information and phone numbers for the Beach Street PPO network, please press 2.
[CUSTOMER][NEUTRAL] For questions concerning pharmacy services, you may contact Caremark at [PII]. To speak to a customer service representative regarding any other issues, please press 3 now or simply stay on the line and someone will assist you. Thank you.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial.
[CUSTOMER][NEUTRAL] Due to severe winter weather, you may experience longer wait times. As this is not an urgent matter, please call back at a later date. Thank you for your patience.
[CUSTOMER][NEUTRAL] Please note, your call may be monitored or recorded for quality assurance. The information provided during this call is only a description of benefits and is not a guarantee of payment. Benefits are based upon eligibility at the time services are rendered and all plan provisions.
[CUSTOMER][POSITIVE] Thank you for calling customer service. My name is [PII]. May I please have the member ID?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] with APL. Um, let me get that for you. Um, the number I have here is 02277644.
[AGENT][NEUTRAL] And let me explain to you a little bit why um this provider is calling. Um she said that she has called before for a claim and um that it was uh voided because it was a large amount and it was sent to us to have it approved. But she's wanted to know if it came back approved and if she gonna get that checked out to her again. So that's why I'm transferring her.
[CUSTOMER][NEUTRAL] OK, um, real quickly, what was the first and last name and date of birth of the patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, let me get that one moment. Let me go back one moment. OK, is [PII] boring?
[CUSTOMER][POSITIVE] That's OK, take your time.
[AGENT][NEGATIVE] I think that's how you say it, boring. Uh, [PII].
[CUSTOMER][NEUTRAL] OK, and so she's calling to check on a claim that we have said was denied because we needed y'all's approval and she wants to check and see if that's been updated since, correct?
[AGENT][NEUTRAL] Yes, yes, yes, that's it.
[CUSTOMER][NEUTRAL] OK, may I have your name one more time?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, if you want to transfer to me I can take it from here.
[AGENT][POSITIVE] OK, thank you. And you say your name is? I'm sorry.
[CUSTOMER][NEUTRAL] Oh, [PII]
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. OK, let me put her in.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. I got Miss [PII] on the line. She's with Web TPA and she's gonna assist you from here.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Thank you, you're welcome.
[CUSTOMER][NEUTRAL] Hi ma'am, my name is [PII]. I'm with customer service. Um, I do believe I heard Ms. So say that your name is [PII].
[CUSTOMER][NEUTRAL] Yes, that is correct. OK, and may I have the name of the office please?
[CUSTOMER][NEUTRAL] Of course, DOP Kanema Memorial Center.