AccountId: 011433970860
ContactId: d5ae2365-ff4c-481e-946f-8fb2ea5746aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321309 ms
Total Talk Time (AGENT): 110658 ms
Total Talk Time (CUSTOMER): 147474 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/d5ae2365-ff4c-481e-946f-8fb2ea5746aa_20250128T16:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Cottonwe physician practice. Um, we received a payment and I think you guys overpaid it, but I just want to make sure you guys are secondary to this person's primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, well, I can definitely help you with the um claim and the policy, and [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yes, my direct telephone number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02385384.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so for this particular product, their claims are processed through web TPA. Um, I can give you the phone number as well as transfer you so you can check on the claim and the payment.
[CUSTOMER][NEUTRAL] Pa
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so that phone number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And before I transfer you over to a representative um for the claim, was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] No, no, I just, I, it's just that we got overpaid on this. I just wanna make sure you guys are secondary listed.
[AGENT][NEUTRAL] OK, well, so just to answer that question, yes, we are, um, well.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Hold on. Let me see what type of policy they have.
[AGENT][NEUTRAL] See, I would still let them answer that because they could have another insurance and this is the only one that we have. With the hospital indemnity, it could be the primary or they could have another one with this since it's limited.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, so I'll go ahead and get a representative on the line for you and then I'll connect you two together and then end the call and or drop the line.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][NEUTRAL] You're very welcome. Well, thanks for calling APL and hold on one moment, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um,
[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.
[CUSTOMER][NEUTRAL] Due to severe winter weather, you may experience longer wait times. If 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][NEUTRAL] Thank you for calling customer service. This is [PII]. May I have the member ID?
[AGENT][NEUTRAL] Hey [PII], I have the member on the line. Um, the member ID, hold on, let me get it for you, is 252385384.
[CUSTOMER][NEUTRAL] Uh, patient's name, date of birth?
[AGENT][NEUTRAL] The name is um [PII], date of birth [PII].
[CUSTOMER][POSITIVE] Thank you, you can go drop on me.
[AGENT][NEUTRAL] OK, and actually I misspoke. This is [PII] the provider. She's wanting to know about a claim that she thinks is overpaid to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I have Web CPA on the line and they'll be assisting you further with the claim, OK?
[CUSTOMER][POSITIVE] Oh, thank you so much. Have a good day.
[AGENT][POSITIVE] You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII], how you doing? OK, just get the member's name and date of birth?