AccountId: 011433970860
ContactId: 062df1af-8f2b-459f-8db2-07b07f3a83c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522760 ms
Total Talk Time (AGENT): 217815 ms
Total Talk Time (CUSTOMER): 212154 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/062df1af-8f2b-459f-8db2-07b07f3a83c8_20250513T20:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], how are you doing?
[AGENT][POSITIVE] I'm doing good. How are you doing?
[CUSTOMER][NEUTRAL] I'm great, thanks for asking [PII]. I have a provider on the phone who's calling about benefits for HR policy. She wanna verify if urgent care is covered under the policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Alright, what's the um policy number that she's calling about? Do you have that?
[CUSTOMER][NEUTRAL] It's 262-1218.
[AGENT][NEUTRAL] OK, you can go ahead and send her on over to me.
[CUSTOMER][NEUTRAL] Alright, do you see the callback number on the um the [PII]. This is the provider. Her name is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 39. Yeah.
[CUSTOMER][NEUTRAL] 01 moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I've got her.
[CUSTOMER][POSITIVE] Hello [PII], I'm gonna send you transfer you over to [PII]. She's gonna better assist you. Thanks for calling APL and have a good day. Goodbye. Thank you, [PII]. Thank you. Bye.
[AGENT][NEUTRAL] You're welcome. Hi, Ms. [PII], this is [PII] with APL.
[AGENT][NEUTRAL] So I understand that you're calling because you're looking for urgent care benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Exactly, yeah, we don't participate with this insurance, so we just want to know if this patient has out of network benefits.
[AGENT][NEUTRAL] OK, and what is the name of your facility, please?
[CUSTOMER][NEUTRAL] It's American River Urgent Care.
[CUSTOMER][NEUTRAL] I have the NPI or tax ID if you need it.
[AGENT][NEUTRAL] No, I don't need that. Um, and which member are you checking on? um, what's the member's name and date of birth?
[CUSTOMER][NEUTRAL] I'm checking for the dependent. OK, um member um name [PII]
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Last name [PII]
[CUSTOMER][NEUTRAL] Birthday, [PII].
[AGENT][POSITIVE] OK, thank you so much and let me check on this policy.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] I'm checking the benefits now for you.
[AGENT][NEUTRAL] OK, and this is just to verify if it's not a guarantee of payment. This policy has an outpatient sickness benefit rider.
[AGENT][NEUTRAL] Where they can go to an outpatient facility.
[AGENT][NEUTRAL] And it pays.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that for me?
[AGENT][NEUTRAL] Yes, it has an outpatient sickness benefit rider where they can go to an outpatient.
[AGENT][NEUTRAL] This is 4 and it pays $75 and this is just a
[CUSTOMER][NEGATIVE] I'm sorry, just the call just get, um, I, I, it's, it's breaking.
[CUSTOMER][NEUTRAL] I'm so sorry. It's just that the call is, it, it sounds like a breaking.
[AGENT][NEUTRAL] Oh, OK. This is just to verify benefits.
[AGENT][POSITIVE] Oh OK I apologize for that.
[CUSTOMER][NEUTRAL] Oh hello?
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Let's see, um, right, yeah, I can hear you now. Can you repeat what you say first, please, because, um, the call got just kind of weird.
[AGENT][NEUTRAL] OK, alright, and this is just to verify benefits. It's not a guarantee of payment. They do have an outpatient sickness benefit rider that pays $75.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $75 for outpatient for urgent care?
[AGENT][NEGATIVE] It's for sick
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] It's for sickness only.
[CUSTOMER][NEUTRAL] For sickness only, um, what is that means, uh, because he's here, I mean she's here because he's sick, obviously, um, and I just want to know if the patient has like an out of network benefit because we don't take that insurance and um if the patient has out of network benefits.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and this policy is um
[CUSTOMER][NEUTRAL] Do we need like authorization?
[AGENT][NEUTRAL] No, you don't need authorization because it's not a major medical insurance. This is a limited benefit hospital indemnity plan and it does have outpatient sickness benefits that pays $75.
[CUSTOMER][NEUTRAL] The insurance pays $75 only.
[AGENT][NEUTRAL] Only, yes.
[CUSTOMER][NEUTRAL] So the insurance will pay $75.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Sorry about that. OK, um, yeah, so the insurance will pay $75 only. That means the patient has to pay the rest for the visit, right?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] We don't give patient responsibility. We let the, the providers determine that, but the policy itself, um, for the outpatient sickness writer pays $75 only.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] All right. Um, and that's not the confirmation of payment from the insurance to, to us, like, uh,
[CUSTOMER][NEUTRAL] To our office, right?
[AGENT][NEUTRAL] Right. You send, you, you send in the claim.
[CUSTOMER][NEUTRAL] If I.
[AGENT][NEUTRAL] You submit the claim, uh, would you like?
[CUSTOMER][NEUTRAL] And how do you guys approve the claim?
[AGENT][NEUTRAL] How do we approve it based on the itemized statement that you send in with diagnosis code and procedure code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see. OK. May I have um
[CUSTOMER][NEUTRAL] Reference number for this call and your name again?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And I will need the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You will need what, ma'am?
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Your first initial or your last name?
[AGENT][NEUTRAL] My my my first initial is [PII], you can use my name, [PII], and today's date for your reference.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And my last initial is [PII]
[CUSTOMER][NEUTRAL] Um, do you have the uh claim?
[CUSTOMER][NEUTRAL] Address to send to send it, please? What's the claim address?
[AGENT][NEUTRAL] Yes, um
[AGENT][NEUTRAL] You can send it um you can also send it electronically. I can give you the payer ID number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. Uh yeah, that's it.
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] [PII], I'm sorry, can you repeat that for me? [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 12 [PII]. OK. Um, OK, [PII]. I got the [PII] box.
[CUSTOMER][NEUTRAL] And the name of the insurance is Public.
[AGENT][NEUTRAL] It's American Public Life.
[CUSTOMER][NEUTRAL] American Li in American public life, OK.
[AGENT][NEUTRAL] American public life.
[AGENT][NEUTRAL] Or you can for sure just put APL.
[CUSTOMER][NEUTRAL] APL OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Right, thank you so much for your help.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII]. I, uh-huh.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Can I, can I get, um, let me just confirm the member ID. I have the policy number 2621218.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, got it. Thank you. Thank you so much.
[AGENT][POSITIVE] You're very welcome. You have a wonderful week and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye bye.