AccountId: 011433970860
ContactId: e5679661-8549-4fbc-a3a3-9f1e2e91d4d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676849 ms
Total Talk Time (AGENT): 277628 ms
Total Talk Time (CUSTOMER): 173874 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/e5679661-8549-4fbc-a3a3-9f1e2e91d4d3_20250123T18:28_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling ATL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, Hi, this is [PII] calling from provider's office, checking for the eligibility information for this member.
[AGENT][POSITIVE] Oh, I'd love to help you with the eligibility today and you said it was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Perfect, Ms. [PII], do you mind if I get a good call back number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the member's policy number today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The member's policy will be?
[CUSTOMER][NEUTRAL] 01899454 M. Mike L. Lima 7.
[AGENT][POSITIVE] Thank you very much. Let me get that pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. And would you be able to verify for me please your insured's first and last name and date of service?
[CUSTOMER][NEUTRAL] Uh, [PII], date of services.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] I'm so sorry. I did say date of service um I meant to say date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] Oh, you said [PII]?
[AGENT][NEUTRAL] And I have the policy number as 1899.
[CUSTOMER][NEUTRAL] Sorry, ma'am?
[AGENT][NEUTRAL] 454.
[CUSTOMER][NEUTRAL] Sorry, ma'am. Will you please repeat again? What is that?
[AGENT][NEUTRAL] 1899454
[CUSTOMER][NEUTRAL] What is it, ma'am?
[AGENT][NEUTRAL] Is that the policy number you just gave me?
[CUSTOMER][NEUTRAL] Yes, 189454.
[AGENT][NEUTRAL] And then the first and last name, [PII], right?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I have just a completely different date of birth for this patient.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], ma'am.
[AGENT][NEUTRAL] OK, I'm so sorry. I just, I, the date of birth I have on here is completely different, um, but what I'm just gonna look at something real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, I don't know, um, anyway.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] You needed eligibility for him, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. Um, so it looks like his policy is no longer active with us. It has not been active since [PII].
[CUSTOMER][NEUTRAL] Can I have the effective date on the
[CUSTOMER][NEUTRAL] Term date
[AGENT][NEUTRAL] Yeah, the effective date was [PII] and the term date is [PII].
[CUSTOMER][NEUTRAL] So, [PII], term on 21.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Acting as a primary or secondary during the.
[AGENT][NEUTRAL] Secondary, we're not a primary insurance carrier.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So there is no active coverage for this member?
[AGENT][NEUTRAL] No, I'm sorry.
[CUSTOMER][NEUTRAL] But uh they are stating they have a coverage for, for this.
[CUSTOMER][NEUTRAL] I will repeat the member ID one more time. Just hold a moment.
[CUSTOMER][NEUTRAL] Is it 01899454 ML 7, is it right?
[AGENT][NEUTRAL] Correct, yeah, they don't have active coverage with us, no, I'm sorry.
[CUSTOMER][NEUTRAL] Can I have the plan name?
[AGENT][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh, no, I'm so sorry. [PII].
[CUSTOMER][POSITIVE] Uh, no, I'm so sorry.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK. So we have some services has been done for [PII]. What is the next step, whether we have to build the patient?
[AGENT][NEUTRAL] I'm really sorry I can't tell you um.
[AGENT][NEUTRAL] What to do? APL does not determine patient responsibility because we're a supplemental insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what should be done?
[AGENT][NEUTRAL] Uh, you'll have to ask the provider's office that that's gonna be up to them.
[CUSTOMER][NEUTRAL] So you have to check with the provider.
[AGENT][NEUTRAL] Yeah it's gonna be up to the provider what to do.
[CUSTOMER][NEUTRAL] And we can do stuff.
[CUSTOMER][NEUTRAL] OK. Can I have the spelling of your name?
[AGENT][NEUTRAL] Yes, it's [PII], first initial, last name, [PII].
[CUSTOMER][NEUTRAL] Can you please provide me the mailing address?
[AGENT][NEUTRAL] Yeah, our mailing address is [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Our zip code here is [PII].
[CUSTOMER][NEUTRAL] Can I have the [PII] one more time?
[AGENT][NEUTRAL] Yep, [PII].
[CUSTOMER][NEUTRAL] Fax number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Attention
[AGENT][NEUTRAL] Uh, you would make it attention to claims.
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Timely filing.
[AGENT][NEUTRAL] We don't have a timely filing limit. You're welcome to submit at any time.
[CUSTOMER][NEUTRAL] But not for the after-term period.
[AGENT][NEUTRAL] I mean he doesn't have coverage with us after [PII] so if you have any claims from when he was active with us you'd be more than welcome to submit that and you can still submit claims but he just wasn't eligible for benefits after.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So we can submit a claim.
[AGENT][NEUTRAL] You can always submit a claim. He just doesn't have benefits payable after his termination date.
[CUSTOMER][NEUTRAL] OK. So we have an option to submit a claim for this member. So once we have submitted the claim, we will be processing and paying.
[AGENT][NEUTRAL] Well, if
[AGENT][NEUTRAL] You can always submit a claim, so I'm not gonna tell you not to submit a claim, um, but what I am telling you is that this member's policy with us was only from [PII], so his benefits will only fall into that period. So if his date of service was in [PII], he, he didn't have coverage with us then he wasn't insured with us so you can submit a claim, you're more than welcome to, but he just wasn't covered.
[CUSTOMER][NEUTRAL] So we
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so we have an option to submit, but you won't be paying because the policy has been terminated.
[AGENT][NEUTRAL] So again, like I can't, I can just tell you that he didn't have active coverage with us in [PII] and you always have the right to submit a claim.
[CUSTOMER][NEUTRAL] OK, but you're stating you don't have any coverage for [PII].
[AGENT][NEUTRAL] Yes, that's what I'm telling you. His policy was only active from [PII]. He has not had any coverage with us since then.
[CUSTOMER][NEUTRAL] OK, so we have to check with the member and submit the claim which was active.
[AGENT][NEUTRAL] Uh, whatever you choose to do will be up to the provider.
[AGENT][NEUTRAL] I can't tell you what to do. I can tell you you always can submit a claim and that his policy was effective from that time period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Reference number, please.
[AGENT][NEUTRAL] Reference number? It's my name and today's date.
[CUSTOMER][NEUTRAL] Do you have group number, group name?
[AGENT][POSITIVE] Yes, I can provide that for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Group number is 242-72.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. Group name?
[AGENT][NEUTRAL] Group name is Vitality Home Care INC.
[CUSTOMER][NEUTRAL] Will you please spell it out?
[AGENT][NEUTRAL] Yep, um,
[AGENT][POSITIVE] It's Vitality, V I T A L I T Y.
[AGENT][NEUTRAL] Home, H O M E.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Care, C A R E.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Inc INC.
[CUSTOMER][NEUTRAL] Planning
[AGENT][NEUTRAL] The plan name I already gave you was [PII]
[CUSTOMER][NEUTRAL] Plan type
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Asking uh whether it is in HMO or PPO what type of plan is it?
[AGENT][NEUTRAL] We're a secondary insurance policy. We're not an HMO or a PPO, that would be for your major medical providers.
[CUSTOMER][NEUTRAL] So there is no
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] No, because we're a supplemental policy, not a major medical policy.
[CUSTOMER][POSITIVE] OK, thank you so much and thanks for your patience. Have a nice day and bye, ma'am. Thank you. Bye-bye.
[AGENT][POSITIVE] My pleasure, Ms. [PII]. You take care.