AccountId: 011433970860
ContactId: 086eb82c-984b-48b5-9034-0bd47934ced3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329609 ms
Total Talk Time (AGENT): 120969 ms
Total Talk Time (CUSTOMER): 194447 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/086eb82c-984b-48b5-9034-0bd47934ced3_20250213T21:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] with High Point Family Wellness. I have a patient and I'm kind of confused on what his benefits are. He's given us two different insurance cards. They have the same ID number, but one says APL and one and and I, it appears to be a um paper card and the other one is a plastic card that has HG staffing on it, but they have the same ID number and they have the same mailing address and things for the um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claims and I'm trying to determine what why he has two cards if the if that means he has two different benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because somebody else called and got requested benefits on this yesterday and I called and verified today but then I'm really confused about what.
[CUSTOMER][NEUTRAL] Why he's got two cards, and there's a difference.
[AGENT][NEUTRAL] Yeah, so there's, it's just 2 cards, it's just 2 cards because the employer has like an employer card that might show all of their enrollments on one card, but APL that's specifically our card. So that's why the policy number and everything is the same. Um, but may I have that policy number? I can pull it up for you and let you know the benefits.
[CUSTOMER][NEUTRAL] Sure, it is, give me, it's D as in David, 41601802.
[AGENT][NEUTRAL] On the APL card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Let me see, give me a, give me one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Brider medical benefit verification customer service 800256 866.
[CUSTOMER][NEUTRAL] Just says attention IMA says it has individual coverage. It has an effective date it has limited benefit plan VIP BIC, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A medical ID number.
[AGENT][NEUTRAL] What's the medical ID number? Is that a 01 or 02 or that the number you just gave?
[CUSTOMER][NEUTRAL] Tells you where to go if you want.
[CUSTOMER][NEUTRAL] D D.
[CUSTOMER][NEUTRAL] Um, and it says where to submit claims to customer service.
[CUSTOMER][NEUTRAL] Um, that's about all it has. It doesn't have anything else on it.
[AGENT][NEUTRAL] Does it have a group number?
[CUSTOMER][NEUTRAL] Um, it did.
[CUSTOMER][NEUTRAL] I thought it did hold on.
[CUSTOMER][NEUTRAL] A policy has a policy cer cert number. I don't necessarily see a group number.
[AGENT][NEUTRAL] Yes, the, the policy er number is the number I'm looking for. It starts with a 01 or 02.
[CUSTOMER][NEUTRAL] Yes, 02566019.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it is [PII]. Hold on, I'm looking up. I've got both cards pulled up. Can let me get a place to where unfortunately it doesn't show his date of birth. Date of birth is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII]. This is a hospital indemnity policy, so it is a limited medical um policy. There is coverage for hospital admission and confinement.
[AGENT][NEUTRAL] Um, surgical benefits for accident and sickness. There's emergency room, urgent care, physician office, um, what would you be considered?
[CUSTOMER][NEUTRAL] We're a primary care provider.
[AGENT][NEUTRAL] OK, so for um physician office, the policy will pay up to $50 for visits per calendar year.
[CUSTOMER][NEUTRAL] And that would include sick or well, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, and these cards doesn't mean anything different, right? You can have one which card would be what would we do I need to leave in because I'm gonna have to delete one of these.
[AGENT][NEUTRAL] The one with APL on it.
[CUSTOMER][NEUTRAL] Delete the APL card.
[AGENT][NEUTRAL] No, no, no, no, no, keep the APL card. The other card is, uh, the other card is just their, like their card from their employer listing all their coverage that they selected.
[CUSTOMER][NEUTRAL] Keep that, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got you and what is.
[CUSTOMER][NEUTRAL] And uh call reference number would be your name last initial what's your last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and today's date 1325. Alrighty, I appreciate it. You have cleared up they were saying somebody from your office told them one was for well visits and one was for sick visits. I'm like, I've never heard that in the entire time I've been doing this for longer than you may have been alive. Yeah, that don't make a lot of sense.
[AGENT][NEGATIVE] Oh Lord, no.
[CUSTOMER][POSITIVE] Not a lick so I've called both cars got it figured out, and now I gotta go tell my boss. I appreciate it. Thank you so much.
[AGENT][NEUTRAL] You're very welcome. And just for the call, all the information provided was a verification of benefits, not a guarantee of payment. [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] No, sometimes I just want my some coworkers to add a little bit of common sense, but anyway, that's, that's it. I appreciate it. You have a wonderful weekend, OK?
[AGENT][POSITIVE] You're welcome. Thanks for calling APO. You too.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.