AccountId: 011433970860
ContactId: f449deb9-81e8-432f-8678-87389bc49244
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371149 ms
Total Talk Time (AGENT): 201293 ms
Total Talk Time (CUSTOMER): 112817 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/f449deb9-81e8-432f-8678-87389bc49244_20250506T13:00_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], I'm calling to verify a member's coverage please.
[AGENT][NEUTRAL] OK. Or do you need eligibility benefits, [PII]? Do you need eligibility and benefits?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yes, eligibility.
[CUSTOMER][NEUTRAL] Just eligibility.
[AGENT][POSITIVE] OK, OK, yes, ma'am, I can help you with that, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII], and that's direct.
[AGENT][NEUTRAL] OK, thank you. And then what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02580644.
[AGENT][NEUTRAL] Thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information [PII] that I did, excuse me, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm. And what is the first name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, now that is not what we show as the first name. That is not how.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. All right, thank you.
[AGENT][NEUTRAL] OK, so I do show we do have her listed as [PII] and she is a subscriber on this limited benefit plan and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], if you will end up filing a claim for her once the claim has been processed by APO, we do have a portal in which you should be able to check claim status, and the website for our portal is located at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I did go there and I got as far as um I was I was a new user like as far as entered the tax ID number and the patient account number I can't figure out what goes in that spot I've tried our patient account number um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that would be what you would use.
[CUSTOMER][NEUTRAL] And the patient's policy number.
[AGENT][NEUTRAL] Right, but you're not gonna be able to check eligibility, and that's gonna only be for claim status at this point. So if we don't have a claim on file for her, you're not gonna be able to locate, you know, with that information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, we received the letter that the patient was um covered that when we file the claim.
[CUSTOMER][NEUTRAL] We received it from Smart Data Solutions.
[AGENT][NEUTRAL] Um, I don't know who that is, but OK.
[CUSTOMER][NEUTRAL] Stating that the insured was not found.
[CUSTOMER][NEUTRAL] So maybe that was IMA incorporated is that where?
[AGENT][NEUTRAL] I don't know who that is.
[AGENT][NEUTRAL] Yeah, now that's, that's a different company. IMA is different than APO IMA is where the uh policy, excuse me, where claims are sent to. That's their clearing house, it goes through their clearing house.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But that's a separate company than I.
[CUSTOMER][NEUTRAL] OK, and where do we file claims with APU?
[AGENT][NEUTRAL] OK, for her policy, they do go to IMA.
[AGENT][NEUTRAL] The claims go to the IMA [PII].
[CUSTOMER][NEUTRAL] OK, that's what denial from.
[AGENT][NEUTRAL] OK, so I don't know. Some of these people have dual coverage where they also have a D number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On their ID cards, that's a separate.
[AGENT][NEUTRAL] Plan from APL that this insured is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She does have an active hospital indemnity limited benefit plan with APO.
[AGENT][NEUTRAL] As of now, we don't, we do not have a termination date and the effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do see where you know we have the member name is [PII] and the patient name is [PII]. Would that be a reason for the denial?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, we, there's not a [PII], there's not a [PII] listed on this policy, so.
[CUSTOMER][NEUTRAL] Looks like her, her, her.
[AGENT][NEUTRAL] There's no one by that name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, that could have been.
[AGENT][NEGATIVE] Maybe why they sent saying that this person was not covered because it's, there is, that name is not anywhere on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have a call reference number and the first initial to your last name, [PII]?
[AGENT][NEUTRAL] Absolutely. My name in today's date will be your call reference number and the first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Alright, we'll get this corrected and we'll get this file back, um, refiled thank you so much.
[AGENT][NEUTRAL] OK. All right then.
[AGENT][POSITIVE] Well, you are very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] That'll be all. Thank you for your help. Have a blessed day.
[AGENT][POSITIVE] OK. You, I hope you have a blessed day as well, [PII]. It was my pleasure in speaking with you this morning. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Same here. Thank you. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.