AccountId: 011433970860
ContactId: e88bdf7c-7525-434b-ac11-d493d0bf9618
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403649 ms
Total Talk Time (AGENT): 168491 ms
Total Talk Time (CUSTOMER): 136790 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/e88bdf7c-7525-434b-ac11-d493d0bf9618_20250512T20:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling NPO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, um, yes, I can bare, oh, I can barely hear you now. I'm sorry, what did you say?
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK, um, my name is [PII] calling from Northside Hospital. I was calling to check the status on a medical claim, and are you guys known, uh, also known as American Public?
[AGENT][NEUTRAL] This is American public life. We're not republic. This is American public life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I am calling from the hospital we're trying to follow up on a claim that we submitted uh to you guys but I'm not quite sure how it works out. This is a medical claim.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. And what is a good call back number for you please, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, callback number direct is area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure, I have 0240655.
[CUSTOMER][NEUTRAL] 8 M as in Mary, L as in Lima and then the number 8.
[AGENT][NEUTRAL] OK, thank you. So give me a moment, [PII] while I get the member's information pulled up and I can see where the name of the company kind of throws you, but we go by APL because we do offer a lot of different type of benefits. It's not just life insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] I see. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, yeah, uh, I'm, well, I'm gonna spell it out for you. Um first name is spelled [PII] The last last name is spelled [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you and what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Your date of service in question, um, [PII], and for this claim, we billed $12,298.50.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you did say [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, so now under this policy number, we do not have a claim on file, but this policy actually termed 101 of 2024. So let me see if you just haven't, yeah, you have an old policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me get the policy, the correct policy information pulled up just a moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so the correct policy number you should have is 02551257.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy has an effective date of 10-1-2024.
[AGENT][NEUTRAL] So let me see if the claim was processed, if it was received and processed under the correct policy number. So just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, we have not received a claim for this member and it's not under either policy for that data service and that bill amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alrighty, um, let me just read back what you gave me. I'm sorry, the policy number that you gave me, you said effective 101, um, yeah, because I said the date of service was, yeah, OK, so did you say um.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, no ma'am.
[AGENT][NEUTRAL] 24.
[AGENT][NEUTRAL] [PII] 24.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's right. OK, so the policy number you said is 02551257, is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and where should the uh claims go for payment?
[AGENT][NEUTRAL] [PII] and we must have a copy of her primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty then I'll go ahead and send this over to our builders to have them rebuild it. Thanks so much. And um is there a call reference number for today?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, you're welcome.
[AGENT][NEUTRAL] Yes, yes ma'am, you'll use my name [PII] along with today's date and then one last thing, we also have a portal that once we have received and processed the claim, you should be able to check the claim status there as well if you go to secured.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty then thanks so much appreciate your help.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Well, you're absolutely, you're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] OK, well then have a great evening and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thanks. uh-huh take care bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.