AccountId: 011433970860
ContactId: 0ff490cf-1a22-42b2-9a2c-8d08fa2faf0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251360 ms
Total Talk Time (AGENT): 95001 ms
Total Talk Time (CUSTOMER): 148197 ms
Interruptions: 1
Overall Sentiment: AGENT=2.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/0ff490cf-1a22-42b2-9a2c-8d08fa2faf0c_20250102T21:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from Mount Sinai Physicians. I'm trying to verify a patient's eligibility.
[AGENT][POSITIVE] OK, I'd love to help you with that, Miss [PII]. Do you have their policy number handy?
[CUSTOMER][NEUTRAL] I have uh let's see um.
[CUSTOMER][NEUTRAL] Give me a second because here they have one number I have D as in David 41,202,810.
[AGENT][NEUTRAL] Alright, so that's gonna be the number for 90 degree benefits. Ours is gonna be maybe 6 to 8 digits starting with a 0.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, I also have another one that says 02510210.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is, uh, let me just move this over because it's blocking my date of birth [PII].
[AGENT][POSITIVE] Wonderful, thank you so much. And your patient is current and active with us. She has an effective date of [PII].
[CUSTOMER][NEUTRAL] And is this a regular medical plan for a physician or is this a hospital plan?
[AGENT][POSITIVE] Yeah, so this is a hospital indemnity plan. It does look like she has an outpatient benefit with us um for sickness and a wellness and diagnostic benefit as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this is a, oh, so it would be both medical, uh, both provider and hospital.
[AGENT][NEUTRAL] Um, yes, uh, yes, she has both inpatient and outpatient benefits on this plan.
[CUSTOMER][NEUTRAL] OK, the only reason I'm questioning it is because the um card kind of threw me off.
[AGENT][NEUTRAL] Oh yeah, I think it'll say like limited hospital indemnity or something.
[CUSTOMER][NEUTRAL] It says.
[CUSTOMER][NEUTRAL] Hospital in [PII] and I work for the physician, not for the hospital, so that's why I need to verify if it's for the physician is covered, patients coming into a regular medical visit of as a new patient today, so I need to make sure that, you know, I'm billing the right, my plans so they do have active coverage as of [PII].
[AGENT][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] [PII] OK and I have that the claims go to [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, now the other plan that I gave you that's not you guys?
[AGENT][NEUTRAL] That policy number it's yeah it's different it's not for us. I don't know how they both work, but.
[AGENT][NEUTRAL] There's IMA offers other benefits too.
[CUSTOMER][NEUTRAL] I know, right, OK.
[CUSTOMER][NEUTRAL] Right, and as far as you're concerned, your primary?
[AGENT][NEUTRAL] Um, we're a supplemental plan, so typically we always fall secondary, but
[CUSTOMER][NEUTRAL] Uh huh, OK, so that other.
[CUSTOMER][NEUTRAL] Yeah, so that other plan may be her primary, so I gotta call them.
[AGENT][NEUTRAL] Yeah, so I think the reason they have it all go to IMA is so they can sort out if there's like a primary that it needs to go to before it comes to us.
[CUSTOMER][NEUTRAL] Hm, yeah, but I still have to check out that other one and see what they're telling me.
[AGENT][NEGATIVE] What they're doing, yeah, you betcha.
[CUSTOMER][NEUTRAL] OK, yeah, because they say send it to us and then we'll say, you know, it's crazy, but I need your first name, the initial of your last name, and a reference number for this call.
[AGENT][NEUTRAL] Easy peasy. So the reference number is my name and today's date and then my name is [PII], first initial, last name [PII], and then today's date.
[CUSTOMER][POSITIVE] Great thank you very much I appreciate your help have a good day.
[AGENT][POSITIVE] Hey, my pleasure, thanks for calling APL you have a great day and happy new year.
[CUSTOMER][POSITIVE] You're welcome you too bye bye.
[AGENT][POSITIVE] Thanks. Bye bye.