AccountId: 011433970860
ContactId: 1bac6291-27a0-4664-89ca-dc76cb072760
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434399 ms
Total Talk Time (AGENT): 221850 ms
Total Talk Time (CUSTOMER): 144521 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/1bac6291-27a0-4664-89ca-dc76cb072760_20250523T13:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] And I had given my new, uh,
[CUSTOMER][NEUTRAL] Benefits information to my cardiologist's office at Mount Sinai and they called this 800 number that I'm speaking to you on and they said that my name was not in their system.
[AGENT][NEUTRAL] All right, [PII].
[CUSTOMER][NEUTRAL] I'm wondering if you can help me.
[AGENT][NEUTRAL] Yeah, let's take a look. Do you have a policy number by chance?
[CUSTOMER][NEUTRAL] Uh, there's a policy slash certification number on this card.
[AGENT][NEUTRAL] Mhm, yeah, it's just say certificate, yeah.
[CUSTOMER][NEUTRAL] Yeah, it's 0259.
[CUSTOMER][NEUTRAL] 552 5
[AGENT][NEUTRAL] OK, let me pull this up here. Give me just a moment.
[AGENT][NEUTRAL] All right, [PII], and then if I could just verify please your date of birth and then address.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][POSITIVE] All right, thank you so much. OK, so yeah, I mean, that pulled up your policy and your policy is active. It's been active since February, um.
[AGENT][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] Did you give them, they had the card itself?
[CUSTOMER][NEUTRAL] No, I gave him whatever information was on the card.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, and they were also told that, um, this is APL is not my primary insurance. They're a secondary or something like that.
[AGENT][NEUTRAL] Well, we do offer like supplemental plans like gap insurance, um.
[AGENT][NEUTRAL] The plan that you have is a limited benefit medical plan, so they call it a hospital indemnity plan. Um, I mean, we don't know if you have other insurance. It could be used as like a secondary, but it's not a gap plan. That's not what you have with us.
[CUSTOMER][NEUTRAL] Well this is the email I got on [PII] from uh North Staffing, the staffing agency I worked through.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Plans, plan changes for current staffing employees through essential staff care. Your benefits will be transitioning from essential staff care to benefits in a car effective [PII].
[CUSTOMER][NEUTRAL] This change will affect your coverage.
[CUSTOMER][NEUTRAL] Uh, etc. etc. So is my personal insurance still as.
[AGENT][NEUTRAL] I'm sorry, the phone kind of cut the phone kind of cut out. So is your primary insurance what again?
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] It says your benefits will be transitioning from essential staff care to benefits in a card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So yeah, this is, that's, this is through benefits and a card, your plan that you have now. That is correct, yes.
[CUSTOMER][NEUTRAL] So it benefits in
[CUSTOMER][NEUTRAL] So my primary insurance is benefits in a car, not American public life.
[AGENT][NEUTRAL] So the plan that you have is through us. Benefits in a card is like a third party who they actually will process the claims, receive the claims and everything of that nature, but in regards to [PII] them calling that the [PII] number that you just called.
[AGENT][NEGATIVE] They should have been able to have verified the benefits that it was a medical plan and not like a gap plan. Um.
[CUSTOMER][NEUTRAL] Huh, uh, OK, so you have my information.
[AGENT][NEUTRAL] So I'm con
[CUSTOMER][NEUTRAL] You know what, let me just call this uh.
[CUSTOMER][NEUTRAL] HR person at this North staffing.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Um, because I need it definitely.
[AGENT][NEUTRAL] The only thing that I can think I was gonna say the only thing I can think, [PII] is on the card if you have the card if you're looking at it you'll see that there's like a there's a policy cert number which is what you gave me which is perfect and then down below under the plan type it says medical ID sometimes providers will give us that number that starts with a D like in [PII] um.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And we, we can't pull you with that information we need that 025 number.
[AGENT][NEUTRAL] The agent should have been able to search by your name, but that's the only thing that I can think that may have been like a miss is if they were giving that medical ID number and they didn't get the policy certificate number.
[CUSTOMER][NEUTRAL] OK, I don't see the medical ID number on here.
[AGENT][NEUTRAL] You don't, OK. Well, then you, that wouldn't have been the issue cause then that wouldn't have been something that you would have given them. You would have given them that 02 number it sounds like then.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh boy, uh, I also have a group number. Does that help? 70094?
[AGENT][NEUTRAL] Yeah, I mean,
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I mean, that is the group associated with it, but yeah, I mean, honestly, I would um
[AGENT][NEUTRAL] If you have the card, I would offer to send the provider a copy of the card to see if that would help them in any way, shape or form, the doctor themselves, but the plan that you have with us is active and they should be able to verify all of that and the claims information should be on the card too. Do you see that where they submit claims?
[CUSTOMER][NEUTRAL] Uh, submit claims. Oh, that's on the back, submit claims to IMA Inc.
[AGENT][NEUTRAL] Yeah, so maybe, yeah, and the payer ID and everything, I don't know if that maybe would help them.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Um, because the payer ID is how they electronically submit claims to us.
[CUSTOMER][NEUTRAL] Oh my, uh.
[CUSTOMER][NEUTRAL] OK, let me just call this office because uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I guess they would be the best idea, but thank you for your time. I do appreciate it. Thank you very much.
[AGENT][POSITIVE] You're welcome. um bye bye.