AccountId: 011433970860
ContactId: ea09a899-c1c2-4939-b005-acac08cdfd44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302609 ms
Total Talk Time (AGENT): 103844 ms
Total Talk Time (CUSTOMER): 104013 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ea09a899-c1c2-4939-b005-acac08cdfd44_20250425T15:59_UTC.wav
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[AGENT][NEUTRAL] I have my sister.
[CUSTOMER][NEUTRAL] Yes, good afternoon. I am calling to see if you have um.
[CUSTOMER][NEUTRAL] This member on one of your plans please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and call back is [PII].
[AGENT][NEUTRAL] Thank you [PII] and what is the member's policy number that you're calling to verify benefits and eligibility for today?
[CUSTOMER][NEUTRAL] It's 023 I'm sorry, 02438540.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Thank you, and you're calling to verify benefits and eligibility, [PII]?
[CUSTOMER][NEUTRAL] Yeah, there's a claim that went out on um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's for medical.
[CUSTOMER][NEUTRAL] And I noticed.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Go ahead with what you were about to say.
[CUSTOMER][NEUTRAL] Well, I was reviewing a previous claim that she had because they've got this insurance in here as IMA and that shouldn't be it, correct?
[AGENT][NEUTRAL] No, this is a third party policy so IMA is the primary and then it they will send a claim here to American Public Life.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah it looks like this one here in August got denied because of.
[CUSTOMER][NEGATIVE] Premium for the service date was not received therefore benefits are not payable.
[AGENT][NEUTRAL] Got you. So could you verify [PII]'s date of birth again for me?
[CUSTOMER][NEUTRAL] Yes, I have, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, do you have a claim number, [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't let me see here.
[CUSTOMER][NEUTRAL] Let me see, let me give me one second, see if I can pull this up.
[AGENT][NEUTRAL] What is the date of service? I can see if I can pull it up that way.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Do you have a procedure code? Just one would be fine.
[CUSTOMER][NEUTRAL] 99214.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 23
[AGENT][NEUTRAL] So it looks like we, we received the claim [PII]. It was processed [PII] and the remarks code states that.
[AGENT][NEGATIVE] Not the member was not eligible for benefits weekly premium not received.
[CUSTOMER][NEUTRAL] And what was the code?
[AGENT][NEGATIVE] So therefore no benefits were available to pay out for the data service.
[CUSTOMER][NEUTRAL] OK, is there a portal that I can retrieve that?
[AGENT][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and I can send it to you by fax if you would like.
[CUSTOMER][POSITIVE] Oh, that would be wonderful.
[CUSTOMER][NEUTRAL] Just let me know when you're ready for my fax number.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And you could just put it to my attention [PII]
[AGENT][POSITIVE] Thank you. I have [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes, that's it, ma'am.
[AGENT][POSITIVE] OK [PII], I'm gonna send this over for you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Can I just get a reference number for our call?
[AGENT][NEUTRAL] Unfortunately, we don't provide those. However, you can use my name and today's date as a reference is S as in [PII] as in [PII], Y as in yellow, L as in Lima, [PII] in today's date.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate all your help. Will that fact be coming over today, dear?
[AGENT][POSITIVE] You're welcome and I'm sending this fax over for you. Yes, it would.
[CUSTOMER][POSITIVE] Alright, alright, thank you so much have a great weekend.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.