AccountId: 011433970860
ContactId: 0a34fec7-9142-4a47-a6ca-c6fb7c0b7da7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504690 ms
Total Talk Time (AGENT): 237145 ms
Total Talk Time (CUSTOMER): 126618 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/0a34fec7-9142-4a47-a6ca-c6fb7c0b7da7_20250527T22:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello ma'am. My name is [PII]. I'm calling from Oreo kidney specialist. I wanted to confirm, uh, eligibility and benefits and, uh, making sure providers and network, uh, for I think a patient has, uh, uh, primary and secondary plan with you guys.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] What's a good uh what's a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's at [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, first one I have, it's uh 026-06581.
[AGENT][NEUTRAL] One moment while I look that up.
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a hospital indemnity plan. It looks like it is active with an effective date of [PII].
[AGENT][NEUTRAL] And were there specific benefits you were needing?
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Yes, I know it's for a specialist office visit.
[AGENT][NEUTRAL] OK, one moment, let me check on that.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Give me one moment while I look that up real quick.
[CUSTOMER][POSITIVE] Take your time and
[CUSTOMER][NEUTRAL] If you don't mind me asking, um, because when I search it up with us, is it connected to 90 degree benefits or multi plan?
[AGENT][NEUTRAL] Um, if it's a 90 degree benefit, you will need to contact them. We can't always look them up on our.
[AGENT][NEUTRAL] Uh, on our system, um.
[AGENT][NEUTRAL] I believe you'll need to call this number and you'll push option 9 if it's 9 or I'm sorry option 1 if it's 90 degree benefit.
[CUSTOMER][NEUTRAL] And uh what about?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And uh let's see what about multiplan because it's on the I guess the card it says to locate a provider visit [PII].
[AGENT][NEUTRAL] Uh, the multi plan, it'll be the same, and I can give you a number for that in just a second.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, let me pull it up.
[CUSTOMER][NEUTRAL] OK, uh, would you still be able to give me like uh the benefits and to see the doctors in your work?
[AGENT][NEUTRAL] Um, yeah, I'm looking up, I'm looking up this one, now.
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][POSITIVE] Well thank you
[AGENT][NEUTRAL] So for 90 degree in multi-plan.
[AGENT][NEUTRAL] Let me see here you will go to IMA.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For that, um,
[AGENT][NEUTRAL] I can help look at what their policy has, but in terms of.
[AGENT][NEUTRAL] Um, let me see, let me double check and make sure that I'm giving you the right information for them.
[CUSTOMER][POSITIVE] OK, thank
[CUSTOMER][NEUTRAL] And as long as she's active with.
[AGENT][NEUTRAL] Yeah, so whenever you're filing for, uh, whenever you're filing or if you need any information on them, uh, whenever you're filing for the, the claims you'll want to contact IMA for all of the hospital indemnity plans with 90 degree, um, and you'll have the phone number [PII] and you'll click option one and I believe you clicked option 2 for.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, to get to us at APL, you'll click option one for uh the hospital indemnity if you have any questions on that that I can't answer.
[AGENT][NEUTRAL] Um, I have their.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Plan pulled up. I don't see anything for a specialist.
[AGENT][NEUTRAL] Um, but let me look.
[AGENT][NEUTRAL] So this plan is for accidents or illness.
[AGENT][NEUTRAL] Um, this is, and I want to say that this is a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] It looks like they do have a rehabilitation benefit and an accident and sickness surgery benefit. Uh, I'm assuming you're not for surgery, you're specifically just a specialist, uh,
[CUSTOMER][NEUTRAL] Just exactly just consults.
[AGENT][NEUTRAL] OK, consult
[AGENT][NEUTRAL] I am seeing a physician's office benefit of up to $100 per day.
[AGENT][NEUTRAL] With a maximum of 4 days per calendar year.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] And what does that mean like up to 100 100 that it will be covered by American public and then they pay the rest or?
[AGENT][NEUTRAL] So we will pay the physician's office visit of up to $100 and then the rest we don't determine patient uh responsibility so it'll be up to them or 90 degrees you'll whenever you file your claim and you need claim status, you'll go through IMA that number that I gave you.
[AGENT][POSITIVE] And click option one and they'll be able to help you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So that's, but that's already after we send the claim.
[AGENT][NEUTRAL] And if they transfer you to us, hm.
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] I was gonna say if they end up transferring you to us then that means that they have probably uh already given us the approval and we can help you with the claim status um but you'll go through IMA first.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's already after we submit the claim, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine. And do you happen to have the claims address, um, the one on the card says [PII].
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Uh, yes ma'am.
[AGENT][NEUTRAL] Yes, and do you have their payer ID or do you need the payer ID number?
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][NEUTRAL] If if you don't mind if I can.
[AGENT][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] OK, and, uh, last question is the doc is doctor in network with this one? I can give you an MPI number.
[AGENT][NEUTRAL] We don't go through networks, so as long as it's um a benefit that's covered under their plan or under their policy um we honor that benefit. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got you. OK, and this is an office visit so it's good.
[CUSTOMER][NEUTRAL] Alrighty, so, um, I think that was pretty much it, but, and, uh, do you give out reference numbers by any chance?
[AGENT][NEUTRAL] We don't do reference numbers, but you can use my name and last initial, so [PII], and today's date.
[CUSTOMER][POSITIVE] Got you. OK, no, um, thank you, man, and I hope you have a good rest of your day.
[AGENT][POSITIVE] Have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you man thank you bye.
[AGENT][NEUTRAL] Bye bye.