AccountId: 011433970860
ContactId: d0b60104-04a3-4cf6-a277-6b12c422a773
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271119 ms
Total Talk Time (AGENT): 81290 ms
Total Talk Time (CUSTOMER): 123681 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/d0b60104-04a3-4cf6-a277-6b12c422a773_20250512T19:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from gastroenterology specialist. I have a claim that was sent back to us, um, basically saying that, uh, the member.
[CUSTOMER][NEUTRAL] You guys couldn't find the correct member policy?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I was just calling to verify benefits for the member. Did I call the right number?
[AGENT][NEUTRAL] Oh yeah, I mean, I can definitely check benefits if they have a policy. What is the policy number that you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have 106300174.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] that.
[AGENT][NEUTRAL] You know what that might be.
[AGENT][NEUTRAL] That might be their social.
[CUSTOMER][NEUTRAL] Uh it might help we sent the claim to Med Plus, but we received the claim back with a letter from APL.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What is the patient's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Huh. All right. That member number didn't come up. I thought maybe it was their social.
[AGENT][NEUTRAL] Let me try by the name. First name is [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And last name was [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, sorry about that.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Um, what state do they reside in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, I'm not even finding a member plan under that name.
[CUSTOMER][NEUTRAL] OK, are you guys connected to Med Plus at all?
[AGENT][NEUTRAL] Um, I mean, I, to my knowledge, I know that like multi plan is somebody that we're linked with. I've never heard of them before though, the one that you named.
[CUSTOMER][NEUTRAL] OK, the Med Plus, OK, uh, it's really weird. We got, so it came back. I have a letter that says American Public Life expanding the benefits horizon.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right here.
[CUSTOMER][NEUTRAL] And then it has the member name and it just says dear business partner, the enclosed information was submitted to American Public Life Insurance Company. However, we're not unable to locate the correct policy with the information provided, then it has a few empty lines that says.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Full name, Social Security, spouse's name, social security number, policy date of birth and then policy number and date of birth for the spouse, but like I said, they have the member has Blue Cross Blue Shield as her primary insurance and Med Plus as her secondary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I was, I would think it would, it should have been a denial coming back from Med Plus, but I thought maybe you guys might be connected so I called you guys.
[AGENT][NEUTRAL] Yeah, I mean, uh, the, um, policy holder, is it the same last name?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, what is the holder policy holder's first name?
[CUSTOMER][NEUTRAL] Uh, let me take a look, see if I can find it.
[AGENT][NEUTRAL] I can just try by that real quick just to make sure.
[CUSTOMER][NEUTRAL] Let's see if it's on the card here.
[CUSTOMER][NEGATIVE] And it is not that is not gonna help. I'm sorry, Ms. [PII]. Well, I guess my next option is to call Med Plus. I'm sorry for wasting your time.
[AGENT][POSITIVE] OK. No, not a problem at all. Sorry, I couldn't find anything for you. I hope you have a good rest of your day.
[CUSTOMER][POSITIVE] No worries. You as well bye bye.
[AGENT][NEUTRAL] All right, bye-bye.