AccountId: 011433970860
ContactId: cc6f9dda-a08d-4463-97bf-91d1b561b635
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687840 ms
Total Talk Time (AGENT): 235730 ms
Total Talk Time (CUSTOMER): 255547 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/cc6f9dda-a08d-4463-97bf-91d1b561b635_20250311T13:28_UTC.wav
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[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi [PII], my name is [PII] and I'm hoping that you can help me today.
[AGENT][POSITIVE] Sure, [PII], I can assist you. How can I assist you today?
[CUSTOMER][NEUTRAL] OK, so we, um, I'm coming from a dentist office. I can give you all of our information if I need when needed, um, but I have two patients that we thought were carrying Carrington Benefit Solutions patients, and then when we called them, they said that they're American public position patients. They gave us a group number, member ID.
[CUSTOMER][NEUTRAL] Um, so I'm just kind of like in this whole insurance mess. I don't really think the information we had for the claims were correct, so I'm trying to get a breakdown and then possibly um once I have all of that be able to resubmit claims.
[AGENT][NEUTRAL] Can I have your name and the callback number?
[CUSTOMER][NEUTRAL] Yep, it's um [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Thank you and what is that policy number, [PII] so I can see what we have going on.
[CUSTOMER][NEUTRAL] OK, it's 00000. So 500 and then 2505437.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um [PII] and her date of birth is [PII]. That's the policyholder.
[AGENT][NEUTRAL] And who are you calling in regards to the claims to see if we received them?
[CUSTOMER][NEUTRAL] Um, [PII] and [PII] and [PII], her son, but [PII]'s breaks.
[AGENT][NEUTRAL] So, give me [PII]'s.
[AGENT][NEUTRAL] So he
[CUSTOMER][NEUTRAL] [PII]'s? OK.
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, let's see what we have.
[AGENT][NEUTRAL] When did you submit a claim to American Public Life? Could you verify the mailing address or the payer ID where you submitted the claims to?
[CUSTOMER][NEUTRAL] Um, no, so we had them under [PII] Be solution and.
[AGENT][NEUTRAL] It is [PII] is just a third party administrator.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Where we process the claims and provide the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so we did not have a member ID and we had a social security number and
[AGENT][NEUTRAL] That's the member ID number that you have the 2505431? I mean 437.
[CUSTOMER][NEUTRAL] Yup, I just, I just got this. I just got this. So I think I have to update everything cause I don't even know if the patient's breakdown is correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's the same. It hasn't changed, but I could assist you with to verify that for you to be on the safe side. Benefi amount $500 per calendar year, $50 deductible policy only covers preventative and basic services, no major coverage.
[CUSTOMER][NEGATIVE] OK, yeah, ours is completely wrong. Is there any way you could fax me a breakdown?
[AGENT][NEUTRAL] Mhm, what's your fax number?
[CUSTOMER][NEUTRAL] It is 231.
[CUSTOMER][NEUTRAL] 7961736.
[AGENT][NEUTRAL] [PII]. May I place you on a brief hold while I send that over for you?
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] You're welcome. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding, [PII]. I apologize for the inconvenience. So I've sent that information over for you. I sent it as a family. I only sent one for the entire family because the benefits are the same.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] Yeah, that's perfectly OK, um, and then can you.
[AGENT][NEUTRAL] And then on that schedule, it's gonna have on the very first page it's gonna give the yearly or max, yearly max, the yearly deductible amount per individual up to $150 per family. It's gonna have the category of expenses, the percentage that it is covered under, it's gonna have the frequencies, it's gonna have the common exclusions, it's gonna have the claims, mailing address, the payer ID and the fax number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great. Thank you so much.
[AGENT][NEUTRAL] It's gonna have a list of procedure codes, the descriptions, and then those letters in parenthesis under the limitation box, under the limitation column, there's gonna be a box on page 4, explaining each letter with the limitation.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um, and then can you just check and see if you received this claim?
[AGENT][NEUTRAL] For which member?
[CUSTOMER][NEUTRAL] It's for, um, [PII], well, [PII] and [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth? You verify [PII]'s but you didn't verify [PII]'s.
[CUSTOMER][NEUTRAL] OK. Sorry. [PII]'s date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm not showing any claims on file for any of the those members that you're calling in regards to today.
[CUSTOMER][NEUTRAL] OK, that's kind of what we thought because we were submitting them not correctly um OK so.
[AGENT][NEUTRAL] Well, even if you were, so if it depends on where you were sending them to like if you had the payer ID of 60801, regardless if you didn't have the policy number they would we would have searched for the member in the system and if we didn't locate the member then we would have sent a letter back saying that we were they were not located we weren't able to locate the member in the system.
[AGENT][NEUTRAL] Then we have a mailing address at [PII] and a fax number which was [PII] so I'm not sure which way you submitted the claims.
[CUSTOMER][NEUTRAL] So we were submitting them to Carrington Carrington maximum Care in [PII].
[AGENT][NEGATIVE] Oh, yeah, you definitely will send them to the wrong place.
[CUSTOMER][NEUTRAL] And then we had a different group number we had different everything on here so um we're.
[AGENT][NEUTRAL] And do you need the group number or do you have the correct one?
[CUSTOMER][NEUTRAL] I have the group number as AMBIC.
[AGENT][NEUTRAL] Hold on, let me see.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's why like we called Carrington and they were like, no, these are American public patients and then they sent us over.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So the group number?
[AGENT][NEUTRAL] It's 70069. It's 70069.
[CUSTOMER][NEUTRAL] 70069, so this is the group.
[AGENT][NEUTRAL] And the group name is ATC Healthcare Services LLC.
[CUSTOMER][NEUTRAL] So it's um OK hang on.
[AGENT][NEUTRAL] A as in Alpha, T as in Tom, C as in Charlie.
[CUSTOMER][NEUTRAL] ATC
[AGENT][NEUTRAL] Healthcare services.
[CUSTOMER][NEUTRAL] Healthcare
[CUSTOMER][NEGATIVE] And then this is not right. The group name is the American public, right?
[AGENT][NEUTRAL] No, the group name is what I just gave you. A as in Alpha, T as in Tom, C as in Charlie Healthcare Service LLC. American Public Life is the company itself who you will be sending the claims to.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] OK, and 70069.
[CUSTOMER][NEUTRAL] And the insurance company is American Public.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK, I'm just waiting for that fax to come over so hopefully I can update all of this. I haven't received it yet. Do you know about how long it takes?
[AGENT][NEUTRAL] I'm not sure, but I did send it to the [PII] number.
[CUSTOMER][NEUTRAL] Perfect. um, OK, I'm gonna wait for that like you said, you have all the breakdowns in there, the claim address, the payer ID is all in there. Once I, um, get all of that, um, I will, um, update everything.
[CUSTOMER][NEUTRAL] And yes, hopefully we can get this mess uh cleaned up. Do you
[AGENT][NEUTRAL] All right, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yep, there's only one other question I have. When did the coverage start for this plan?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] So [PII]. OK, alright, thank you so much. You guys should be receiving claims from December here hopefully in the next couple of days once I, yeah, if I have any questions I will call back.
[AGENT][NEUTRAL] Well, we'll be here.
[AGENT][POSITIVE] We definitely be here for you, [PII]. Well, thanks for calling APL and you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Goodbye.
[CUSTOMER][NEUTRAL] Bye.