AccountId: 011433970860
ContactId: 0fc327cf-bd1b-432f-bcf9-9a0d1368f040
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2166320 ms
Total Talk Time (AGENT): 652430 ms
Total Talk Time (CUSTOMER): 826375 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/0fc327cf-bd1b-432f-bcf9-9a0d1368f040_20250523T18:26_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] Hello, [PII]. This is [PII] calling from Benefits in a cart.
[AGENT][NEUTRAL] Hi, [PII], how are you doing today?
[CUSTOMER][NEUTRAL] Doing OK. How are you?
[AGENT][POSITIVE] I'm well. How may I assist you today?
[CUSTOMER][NEUTRAL] OK, I have a member on the other line, um, he said that his cardiologist called IPL and he gave me the same number [PII], and then the cardiologist's office was told that he has no coverage with APL and in our here on our system it he shows active, so I'm wondering if we can check that, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, sure, I can definitely check the policy for you. Um, sir, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, our phone number, uh, benefits in the card [PII].
[AGENT][NEUTRAL] All right, and the member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. 02612621.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and he's uh [PII].
[AGENT][NEUTRAL] And the policy number is 2612621?
[CUSTOMER][NEUTRAL] No, it's 02612621. That's what it says policy number.
[AGENT][NEUTRAL] OK, the reason I'm asking is because the policy that policy number is bringing up a different member. Um, what's the member's first and last name?
[CUSTOMER][POSITIVE] Oh, I'm sorry, I'm sorry, I'm sorry. I'm sorry. You're correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was checking another policy off. OK, I got it. [PII].
[AGENT][NEUTRAL] And the policy number whenever you're ready.
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] Hold on. It's, it's unloading. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] I got the card here as an example.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK, policy number 2595525.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Sure, ma'am.
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so let's see, and this is for cardiology, like an in-office appointment or what is he trying to?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] In office.
[CUSTOMER][NEUTRAL] Um, I think, I think it is in office. Uh, he's on the other line. He, he just told me that the cardiologist called to APL and then someone there told him that he is not active, that he, he's not showing on the system.
[CUSTOMER][NEUTRAL] And he shows active here on our end.
[AGENT][NEUTRAL] OK, um, I'm not sure who they call. We don't have any, uh,
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I don't know who they spoke with or who, who, who they called because we don't have any notes here. We have a chiropractor that called, um, but we still gave him the benefits, uh.
[AGENT][NEUTRAL] I, I don't know. If you want to have the, the, can he give us the number to the cardiologist? I can give them a call, but they did not call APL.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, OK, I don't have that information. Can I just transfer the call with you for you to inform him?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Cause I'm done from my, my end. I mean, it's, OK. So uh please let me make a warm transfer.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] And um that way I can explain him who you are and he's gonna keep going with you, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'll be right back with you. Please don't disconnect the call and I really appreciate [PII]. Thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm with APL, um, so I was helping [PII], um, I'm sorry that the card I don't know who the cardiologist called. They haven't called us, but you do have coverage. Um, is there a number that I can, do you have their number? I can give them a call.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] I do so I gave them your number and they looked me up and they looked me up in APL and said we don't have a Julian Diarus with this birthday and this information so that's why I was declined.
[CUSTOMER][NEUTRAL] Um, I can give you the number to, uh, to the doctor's office.
[AGENT][NEUTRAL] OK, I'll give them a call and verify the benefits with them, but um I don't I don't know if how they.
[AGENT][NEUTRAL] I don't know who they call. They, they didn't call us, but I can definitely call them and get it straight for you. What's the phone number that you have?
[CUSTOMER][NEUTRAL] Uh, phone number I have is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, do you mind if I place you on just a brief hold? I'm just gonna call them on the other line.
[CUSTOMER][POSITIVE] Take your time. Let's get this straightened out.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Mount Sinai Fooster Heart Hospital Cardiology Park Avenue South. We're now located at [PII]. Please listen carefully as our menu has changed. If this is a medical emergency, please hang up and dial [PII]. This call may be monitored for quality and training purposes.
[CUSTOMER][NEUTRAL] To schedule or reschedule an appointment or if calling from a doctor's office or if you need test results, please press 1. If your call is a routine matter, please utilize MyChart for such needs as quick and convenient service. Use our automated phone system. Press 1 to listen to your upcoming appointments, or press 2 to cancel appointments. Press 3 to connect with a representative for personalized assistance with your appointments.
[CUSTOMER][NEUTRAL] At Mount Sinai, we always strive to improve the patient experience. To help us better understand how we can better serve you in the future. Please stay on the line after your call is completed for a brief survey.
[CUSTOMER][NEUTRAL] Hello, thank you for calling Mount Sinai Health System. This is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling from American Public Life. We have a mutual patient. Um, sounds like you all are trying to verify benefits for him. Um, I don't know who called, we don't have any record of someone calling, but they denied him to be seen. So I'm just trying to verify benefits so that we can get this patient seen.
[CUSTOMER][NEUTRAL] What do you mean verify benefits?
[AGENT][NEUTRAL] As in like eligibility if the policy is active or not?
[CUSTOMER][NEUTRAL] What's the patient's date of birth?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] What's the patient's phone number?
[AGENT][NEUTRAL] Phone number? Hold on one moment.
[AGENT][NEUTRAL] What we have on file is [PII].
[CUSTOMER][NEUTRAL] Name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He's on the line as well.
[CUSTOMER][NEUTRAL] OK. I'm gonna place you on hold one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mr. [PII],
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, so that, that wasn't me, that's the cardiologist's office. Um, so what's happening? Are they trying to verify your benefits to see if the policy is active?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, because that's what I told her. I just wanted to make sure I was understanding.
[CUSTOMER][NEUTRAL] So that I can go see the cardiologist.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I need to go see the cardiologist because.
[AGENT][NEUTRAL] That's what I told her.
[CUSTOMER][NEUTRAL] I'm almost out of my blood pressure medication. I need to pay him a visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's what I'm trying to figure out.
[CUSTOMER][POSITIVE] I love the music.
[AGENT][NEUTRAL] Because I, I said, I told her, I said somebody, they're trying, you all are trying to verify his benefits and I'm just trying to go over his policy with you and she's like, um, so she put me on hold.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I gave them the ATL 800 number and they said we don't have a Julian Diara.
[CUSTOMER][NEUTRAL] Now it might be a birthday mistake on their end. I, I don't know what the issue is.
[AGENT][NEUTRAL] Mhm, because when I um
[CUSTOMER][NEUTRAL] But I need to get uh.
[AGENT][NEUTRAL] The policy number that she gave me, it pulled right up. I didn't have any issues, so and there's no notes here also, so I don't know who they
[AGENT][NEUTRAL] But if if whoever they spoke with couldn't find a policy, there wouldn't be any notes.
[CUSTOMER][POSITIVE] Oh, listen, my friend, I've been trying to figure this out for a few weeks now. So if you can solve this for me, that'd be great.
[AGENT][NEUTRAL] OK, well, I'm definitely gonna do all I can, um, but.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm just reading through the notes right now to try to get caught up. You're welcome. My name is [PII].
[CUSTOMER][POSITIVE] Thank you. What is your name?
[CUSTOMER][NEUTRAL] [PII], how are you? Thank you for holding we are no longer in network with his insurance.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] I'm doing good. You're welcome.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] We are we are no longer in network with his insurance.
[AGENT][NEUTRAL] It's a hospital indemnity policy. There is no network.
[CUSTOMER][NEUTRAL] We don't take first health.
[AGENT][NEGATIVE] This is not First Health.
[CUSTOMER][NEUTRAL] Well, that's what's on the patient chart, so where are you calling from?
[AGENT][NEUTRAL] OK. So I'm just trying to assist the patient. Hold on, sir, hold on, because I don't even, I'm just trying to assist the patient. So if the the information on file is incorrect, that's what I'm calling for to provide you with the correct information. So what do you have on file?
[CUSTOMER][NEUTRAL] My, on my.
[CUSTOMER][NEUTRAL] OK. So what's the name of the insurance that you're calling from?
[AGENT][NEUTRAL] We are American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, one second.
[CUSTOMER][NEUTRAL] So, American Republic?
[AGENT][NEUTRAL] No, American Public Life.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And is this like under a different insurance?
[CUSTOMER][NEUTRAL] Is there a secondary name?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] OK. So, unfortunately, when I search this insurance, it nothing comes out. I wouldn't even be able to add it to the patient's chart.
[AGENT][NEUTRAL] So does he need to file the claim?
[CUSTOMER][NEUTRAL] Uh, can I jump in here?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So, I got an email.
[CUSTOMER][NEUTRAL] Back in [PII], that my benefits was transitioning from essential staff care to benefits in a card.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And with those deductions taken from my paycheck.
[CUSTOMER][POSITIVE] Oh [PII], one thing I can offer you is.
[AGENT][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] If you confirm your email for me, I'll send you an email. I, I would just need a picture of the front and back of your insurance card so I can escalate this matter to the rev team.
[CUSTOMER][NEUTRAL] You got it. Uh, my email is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I'm gonna send the email while you guys are on the line. You confirm when you receive it and when you have the chance, you just add the attachment to it, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm in front of my computer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, once I receive your email, if I'm unable to add the insurance to your chart, I'll give you a call with the status on that, and then I'll send it over to the rev team, OK?
[CUSTOMER][NEUTRAL] So, what are we doing?
[CUSTOMER][NEUTRAL] I'm going to wait until you receive my email. Once I've received the email you sent back, I'm going to try to upload it on your chart, get it verified, and if I'm not able to, I'm not able to do that, I'm going to escalate. But I'll give you a, uh, your call on the status, OK?
[CUSTOMER][NEUTRAL] OK, I have not gotten that email yet.
[CUSTOMER][NEUTRAL] I haven't sent it.
[CUSTOMER][NEUTRAL] Oh, sorry. It's OK.
[AGENT][NEUTRAL] What's your name, ma'am?
[CUSTOMER][NEUTRAL] My name is [PII]. What's your name?
[AGENT][NEUTRAL] Alright, thank you, [PII]. I'm [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, that's got this.
[CUSTOMER][NEUTRAL] OK, I just sent it over. Let me know when you receive it.
[CUSTOMER][NEUTRAL] Have you refreshed?
[CUSTOMER][NEUTRAL] Me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so once I get that email, I'll go ahead and upload it on your chart. OK, I'll give you a call.
[CUSTOMER][NEUTRAL] OK, so what do I do with this?
[AGENT][NEUTRAL] So you're gonna email her the
[CUSTOMER][NEUTRAL] Um, I need you to take a picture of the front and back.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] So you're just gonna email her the front and back of your card and then when she gets it, she's gonna call you.
[CUSTOMER][NEUTRAL] Will I take a picture of the front and back?
[CUSTOMER][NEUTRAL] OK, great, coming right up. Do you guys wanna stay on or?
[AGENT][POSITIVE] [PII], you can drop the line if that's all. Thank you very much for helping us.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][POSITIVE] OK, have a great day bye bye.
[AGENT][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][POSITIVE] On a scale of 1 to 5, where 5 is very satisfied to 1 where you're very.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm here.
[AGENT][NEUTRAL] Um, so when you, OK.
[CUSTOMER][NEUTRAL] All right, hold on, I'm gonna send this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so who am I gonna send this picture to?
[AGENT][NEUTRAL] You're sending it back to um [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Wait for that to come in.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEGATIVE] Come on that.
[CUSTOMER][POSITIVE] All right, let's try that.
[CUSTOMER][NEUTRAL] OK, so here's my picture. I'm gonna send it back to.
[CUSTOMER][NEUTRAL] Ms. [PII] in a reply.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Is that?
[CUSTOMER][NEUTRAL] OK, upload.
[CUSTOMER][NEUTRAL] So am I sending it just to her or to you as well?
[AGENT][NEUTRAL] Um, just to her, so they can verify um and get you scheduled.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh my, this has been such a nightmare. They switched my healthcare, didn't tell us nothing.
[CUSTOMER][NEUTRAL] Just, this is what you got, and uh I don't.
[CUSTOMER][NEGATIVE] It's bad.
[AGENT][NEUTRAL] Well, hopefully after we send this card,
[CUSTOMER][NEGATIVE] It's bad cause I call office.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, it's just I call doctor's offices. I'm like, American Public Life, benefits in the car, they're like, we never heard of them.
[CUSTOMER][NEGATIVE] Um, and it's the worst, so I'm paying out of pocket.
[CUSTOMER][NEGATIVE] Totally on my end, and this is just a mess.
[AGENT][POSITIVE] Oh my gosh. Well, I'm definitely sorry that you're having to go through this. Um, hopefully after we get them this card, they'll be able to start billing us, um.
[AGENT][NEUTRAL] I'm glad that we were able to get Crystal and hopefully, well, it's going straight to her, so I don't see why.
[AGENT][NEGATIVE] I really could have just verified with her over the phone, but I don't think she understands.
[CUSTOMER][NEUTRAL] All right, so do you have, cause I had a, my back was broken. I went to see a specialist here in [PII]. It was $500. I put it on my credit card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I got a check for $50.
[CUSTOMER][NEUTRAL] $50 out of $500.
[CUSTOMER][NEUTRAL] Um, so the rest is on me. So I'm just trying to figure out how all this stuff works.
[AGENT][NEUTRAL] So if
[CUSTOMER][NEGATIVE] Right, I can't even find a primary doctor on the website.
[CUSTOMER][NEUTRAL] That I can go to, because they have a giant list, and then when I call them, they're like, I never heard of you.
[AGENT][NEUTRAL] So [PII]me
[CUSTOMER][NEGATIVE] So it's just been uh a giant mess.
[AGENT][NEUTRAL] So anytime you have, if you ever receive pushback, just give them your policy number and our phone number and tell them to call us to verify benefits. Now this is a limited medical benefit. It's not like a major insurance, um, like Blue Cross Blue Shield or Cigna. So it's a list of covered services and how much the policy would pay towards it.
[AGENT][NEUTRAL] So, it depends on what
[CUSTOMER][NEUTRAL] OK, what, what do you see?
[CUSTOMER][NEUTRAL] I'm sorry. What do you see is my policy number?
[AGENT][NEUTRAL] It's 259.
[AGENT][NEUTRAL] 552 5.
[AGENT][NEUTRAL] On your card, it'll say in hospitals or
[CUSTOMER][NEUTRAL] OK. So if I call,
[CUSTOMER][NEUTRAL] It says plan limited benefit med plan.
[AGENT][NEUTRAL] Do you see anywhere on the card that says inhospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I do not.
[AGENT][NEUTRAL] What other information is on the
[CUSTOMER][NEUTRAL] I have a group number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, when I wrote down myself on the front of the card says group number 70094.
[CUSTOMER][NEUTRAL] Um, below that is a 2869. I don't know if that was part of the group number.
[CUSTOMER][NEUTRAL] I have an effective date of [PII].
[CUSTOMER][NEUTRAL] Limited benefit plan. On the back.
[AGENT][NEUTRAL] Do you see
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Hold on one second. Do you see APL to the top left corner of your card?
[CUSTOMER][NEUTRAL] Tell me.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] And it says group North Staffing Group LLC.
[AGENT][NEUTRAL] And then in short, the
[AGENT][NEUTRAL] I'm trying to see if you're if you're looking at our card or the benefits in a card copy. It sounds like it's benefits in a card copy.
[CUSTOMER][NEUTRAL] Yeah, no, it says the
[CUSTOMER][NEUTRAL] It says the group LLC.
[AGENT][NEUTRAL] Mhm. And then under it says insured employee name.
[CUSTOMER][NEUTRAL] That's my name, right?
[AGENT][NEUTRAL] Coverage and then policy, sir?
[AGENT][NEUTRAL] Number
[CUSTOMER][NEUTRAL] Uh, coverage individual.
[AGENT][NEUTRAL] And then under it says
[CUSTOMER][NEUTRAL] I see 0.
[AGENT][NEUTRAL] That's the number I just gave you. That's your policy number.
[CUSTOMER][NEUTRAL] 0259.
[AGENT][NEUTRAL] I'm just showing you how to locate the policy number on your card.
[CUSTOMER][NEUTRAL] 5525. Now beneath that it says effective date and beneath that it says plan.
[AGENT][NEUTRAL] Mhm. So you have the correct copy. I was just making sure that you that because there's two versions out there. Um, so I was just making sure you have the correct version, but yes, that's the APL card and that policy er number is your policy number.
[CUSTOMER][NEUTRAL] OK, now,
[CUSTOMER][NEUTRAL] Hold on, work with me here, [PII]. Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So APL is not my primary insurance.
[CUSTOMER][NEUTRAL] Is it? You're a secondary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what [PII] told me.
[AGENT][NEUTRAL] But that's not true though. We have multiple policy types. For your part, we do have some that were secondary insurance and then others like the hospital indemnity policy were not secondary. Secondary means there's a primary insurance that we are second to that that you don't have that type of policy. So [PII] was wrong in saying that to you. The type of policy that you have is a hospital indemnity policy, which as it says, is a limited medical benefit plan.
[CUSTOMER][NEUTRAL] OK, so I do do I give them the name APL or multiplayer?
[AGENT][NEUTRAL] So you
[CUSTOMER][NEUTRAL] That says on the bottom here.
[AGENT][NEUTRAL] You just give them your card.
[CUSTOMER][NEUTRAL] Cause what
[AGENT][NEUTRAL] And tell them on the back of the card, it shows.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Good. I
[AGENT][NEUTRAL] Go ahead, sir.
[CUSTOMER][NEUTRAL] No, no, yes please.
[AGENT][NEUTRAL] If any, if at any time, any provider gives you pushback, you give them your card and you say on the back of my card shows the medical benefit verification number, call customer service. So that way you don't have to go through all this back and forth and and all of that with them. You let us handle it.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] I gave [PII], my cardiologist.
[CUSTOMER][NEUTRAL] Office, all this information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they called me this morning and said, APL you are not in their system.
[CUSTOMER][NEUTRAL] Now let me tell you something uh about a month back.
[CUSTOMER][NEUTRAL] Uh, I was trying to pick up a prescription at CVS.
[CUSTOMER][NEUTRAL] And uh APL had my birth date as [PII].
[CUSTOMER][NEUTRAL] And that was a whole long phone call, right there at the CBS counter, and they finally got it figured out.
[CUSTOMER][NEUTRAL] Do you see my birthday?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On your system there?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What is it?
[AGENT][NEUTRAL] It shows [PII].
[CUSTOMER][NEUTRAL] OK, good. So that was straightened out because that was a mixed up.
[CUSTOMER][NEUTRAL] Uh, back then.
[CUSTOMER][NEUTRAL] So now, uh, [PII] called me this morning and said you are not in ATL. We can't find you when we called them. So how do
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So then we're gonna have to do the same thing that we just did with crystals, um.
[CUSTOMER][NEUTRAL] What do we do here?
[AGENT][NEUTRAL] I don't know. I, I mean, I can't speak for them. I don't know how who they're reaching out to, but that, that policy number that [PII] gave, um, that pulled you right up. I didn't have any issues.
[CUSTOMER][NEUTRAL] I'm just
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So I don't know if they're calling and they're not giving the correct information. I don't know, but if you want me to call them like we just did your cardiologist, I don't have a problem with that. What we need to do to get you what you need.
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] Um, OK, well, I gave you that number, right? You call them and.
[AGENT][NEUTRAL] Oh, that's, that's the same people that we just called. Oh, OK, I I thought it was two different providers. OK. Well, then it's already done. Once she gets the copy of your card, she's going to put it in the system for verification.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If a provider says we're not in their system, we can't help that. That's their system. All we can do is verify the benefits and tell them how to file the claim. So I don't want you to get like, you know, frazzled or anything when they say that we can't help what's in their systems, but you have coverage and we can tell them how to file the claim.
[AGENT][NEUTRAL] They have to figure out their systems on their end.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][POSITIVE] I got you. So with my previous insurance called Essential Staff Care through this company, right? So my doctor visit would be covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Right? And, and now it's not.
[CUSTOMER][NEUTRAL] Uh, so I'm just wondering.
[CUSTOMER][NEGATIVE] What's the point of this fucking insurance, excuse my language.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Um, if I gotta pay for it myself, what
[CUSTOMER][NEGATIVE] Who's covering me? I, I seem to have no coverage here.
[AGENT][NEUTRAL] So you may want to reach out.
[CUSTOMER][NEUTRAL] So that's it. No, no, no, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, I have reached out to them. I get uh a voicemail, I get a recording, I get, I get nothing.
[AGENT][NEUTRAL] Reached out to who because I didn't finish.
[CUSTOMER][NEUTRAL] I'm reaching out to No Staffing, which is the company I work for.
[AGENT][NEUTRAL] But what I was gonna say is you have to reach out to.
[CUSTOMER][NEUTRAL] And I've called
[AGENT][NEUTRAL] If the policy that you have that go ahead sir.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, I, I've reached out to benefits in the card.
[CUSTOMER][NEUTRAL] And they said, yes, you're covered.
[AGENT][NEUTRAL] Right, but if you'll allow me to finish, I'm trying to
[CUSTOMER][NEGATIVE] But APL says I'm not covered.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] I continue.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Thank you. So what I was gonna say to you is this policy is a hospital indemnity policy, so it is a a limited policy, but benefits in a card may have other
[AGENT][NEUTRAL] Other plans or other policies that may fit you better, like when they give you the different plans that you can choose from to elect for your benefits, every, every provider is different, so I don't know what they gave you to to select from, but if this doesn't work for you, there may be another policy that does have more of what you need, um, but I'm saying benefits in a card because that's
[AGENT][NEUTRAL] That's who sends everything to us in writing so that we can create the policies or terminate the policies.
[AGENT][NEUTRAL] So I don't want, I'm just saying I don't want you to feel like you don't have other options. We can see if there's another type of policy that works for you. This is what was selected, but if this doesn't cover what you need, let's see if there's something else. I'm just trying to get you a solution.
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][NEGATIVE] This is so confusing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, so should I wait to hear back from.
[CUSTOMER][NEUTRAL] The crystal.
[AGENT][POSITIVE] Yes, um, so 44, I'm sorry?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on, I'm sorry. She just wrote back. I am now escalating this matter with the rev team.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Allow us some time to work on this matter.
[CUSTOMER][NEUTRAL] You know what the red team is?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm assuming revenue, but I don't know, she shouldn't have put an abbreviation. Um, but all she's saying is she couldn't add the card to their system, which makes sense because she said that they couldn't find this in the system and she's escalating it so that they can um correct their system.
[AGENT][NEUTRAL] Which is all they can do.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] But if this policy doesn't fit what you need, I would um definitely reach out to benefits in the car and I'm saying that because, because it's through the employer, we can't make any changes and all of our policies are through the employer. So they, you make the changes with them, they notify us.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Well, let me see uh what she comes back with.
[CUSTOMER][POSITIVE] I really appreciate your time.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome. You're welcome. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Not that I know of.
[AGENT][POSITIVE] OK. Well, if you need anything, I'm the only [PII] here, so I'll be more than happy to help you. You're welcome.
[CUSTOMER][POSITIVE] But thank you for your time.
[CUSTOMER][NEUTRAL] Well, I will ask you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, thank you very much for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] All right. You too. Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Uh, bye.