AccountId: 011433970860
ContactId: 1daa6614-6501-482f-ad13-c83e6097d0de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 767900 ms
Total Talk Time (AGENT): 354268 ms
Total Talk Time (CUSTOMER): 227236 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/1daa6614-6501-482f-ad13-c83e6097d0de_20250527T19:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, did you say your name was [PII]?
[AGENT][NEUTRAL] I do. Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII], my name is [PII] and it's spelled [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The initial to my last name is [PII]. Can I get you to spell your, is it with a [PII] on the end or [PII]?
[AGENT][NEUTRAL] Neither. [PII] and first initial to my last name, [PII] is [PII]
[CUSTOMER][NEUTRAL] As it saying
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is a good call back number for you, [PII]?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Mhm. Thank you. And how can I help you today?
[CUSTOMER][NEUTRAL] So I'm calling [PII]. I'm not sure if I'm in the right area or not first of all, I have a patient that is inpatient at my our facility.
[AGENT][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I need to verify benefits and coverages for inpatient admission from the emergency room.
[AGENT][NEUTRAL] All right, so you need to verify eligibility and benefit information. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, I can, I can help you with those things. And then what is um your patient's policy number?
[CUSTOMER][NEUTRAL] Bear with me. I'm gonna go back and get it. I.
[CUSTOMER][NEUTRAL] It's all the way over here, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The policy number I have for her is D as in Delta 43703504.
[AGENT][NEUTRAL] OK, thank you. Now, [PII], that is not an APL policy number, that is an IMA or 90 degree benefit number.
[AGENT][NEUTRAL] Does this number also have a policy with APL?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Some of the, some of these members have dual coverage. Some of them may only have APL, some of them may only have 90 degree benefits, um.
[CUSTOMER][NEUTRAL] OK, so on the card I see it says a multi plan preventive preventative services only.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm not sure what she, I mean, I think she's using it as a supplemental to her United Healthcare plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And now, OK, so that information that you're reading me doesn't indicate she has a policy with us. Do you know, uh, do you have the subscribers full social that I could see if they have a policy before I connect you to 90 Degree benefits and save you from being transferred back?
[CUSTOMER][NEUTRAL] It, but I'm not.
[CUSTOMER][NEUTRAL] OK, let me see, let me find her social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think her husband is the policyholder though, but her social is [PII].
[AGENT][NEUTRAL] OK, well, all right, hold on. If, if she's not the subscriber, I need whoever the subscriber is.
[CUSTOMER][NEUTRAL] OK, I don't have his social I don't think.
[CUSTOMER][NEGATIVE] Yeah, they don't give me his.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] And, and they don't, we don't, we can't search by other social other than the subscriber. What is the, what is your patient's name? I can try that, but I can't search by date of birth, so.
[CUSTOMER][NEUTRAL] Oh my God. Her name is [PII], and that's my name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Exactly yes.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] This, this may take us a minute. Now, [PII], just out of curiosity, did you call [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Bear with me. Let me see.
[CUSTOMER][NEUTRAL] Yes, that's the number I dialed that's the number that's on her card.
[AGENT][NEUTRAL] Right, and when you're listening to the prompts, option one is for IMA or 90 degree benefits and then option two is for APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I probably didn't understand it, so I need to call back.
[AGENT][NEUTRAL] So let me
[AGENT][NEUTRAL] Hold on. Let me see. I'm still looking. It's the system is still searching.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let's see here.
[AGENT][NEUTRAL] I may have what, I may have located a policy, not sure yet. What is Ms. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so let me just uh
[AGENT][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] What's her husband's first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And how does he spell [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So we only have it with coverage we have he has with us has one R. That's why I was asking.
[CUSTOMER][NEUTRAL] It's probably the same and we may have it misspelled it's it's just.
[AGENT][NEUTRAL] OK, this matches her date of birth. OK, so the policy number for this limited benefit plan that she has with APL is 214.
[CUSTOMER][NEUTRAL] So much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6942.
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, but do you know if it's a medical? Does she have a medical plan, or is it for because on the card it says preventative services only, which might mean.
[AGENT][NEUTRAL] And they
[AGENT][NEUTRAL] Right, but she's, they have another card. You should have, they, they also have a card that has that policy number that I just gave you on it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For this policy that she has with APL?
[CUSTOMER][NEUTRAL] She has with whom?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] APL, which is who I'm with.
[AGENT][NEUTRAL] That D number you first gave me?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sounds like it goes with the ID card that you have. Do you see that policy certificate number anywhere on the card that
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You have a copy of.
[CUSTOMER][NEUTRAL] Let me bear with me, let me go back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you said the numbers are 21469.
[CUSTOMER][NEUTRAL] Yes, he has one R in his name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, coverage is subject to plan provisions and limitations.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It would be on the front. That, OK, so there, he has another card somewhere that has that information that I gave you on it.
[CUSTOMER][NEUTRAL] No, I don't see that now.
[AGENT][NEUTRAL] In addition,
[CUSTOMER][NEGATIVE] Oh my [PII], no.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes. So, again, this limited benefit plan is active with a pill as of [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Are you saying APO as in Oscar or APS?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] APL, L as in Larry.
[CUSTOMER][POSITIVE] OK, thank you, I'm sorry.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, so just a moment for me to get this benefit, Nikina and.
[AGENT][POSITIVE] The benefits rather pulled up on here.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Now, is she um, she's been admitted as an actual inpatient into a room in the hospital?
[CUSTOMER][NEUTRAL] She is
[AGENT][NEUTRAL] Is that right? What I understood.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so on this limited benefit plan that she has, Nykina, the hospital confinement benefit is $50 per day.
[CUSTOMER][NEUTRAL] The uh.
[CUSTOMER][NEUTRAL] That's what she will pay or that's what you all pay?
[AGENT][NEUTRAL] That's what this plan pays if the claim is approved.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And since it's a limited benefit plan, there's no free required, correct?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you um will end up filing a claim with us once the claim has been processed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] By APO we have a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And that portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Again, that's
[CUSTOMER][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] Like [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and [PII], is there a call reference to the call?
[AGENT][POSITIVE] Yes ma'am, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, so I should change that policy number, uh, to this number that you gave me the 2146942?
[AGENT][NEUTRAL] That is the policy number for APL for that plan that has the hospital benefit that I just provided for you.
[AGENT][NEUTRAL] And then if you have any questions regarding benefits associated with that number beginning with a D, then you would need to speak to IMA again you call the correct phone number, but it would just be option 1 and I can actually connect you over there if you would like for me to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't think I need to speak with him since I called the correct number, right?
[AGENT][NEUTRAL] Well, we're two different companies with two different sets of benefits.
[AGENT][NEUTRAL] Just, they can't provide you the benefit information that I just gave you, just like I can't provide you with whatever their coverage is.
[AGENT][NEUTRAL] A revolving around that D number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so where do we send the claim? Do I send it to the IMA post office box?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Mhm. 21704. That's correct.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] All right. Well, you're welcome. And again, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Have a good day.
[AGENT][POSITIVE] I hope you have a good day too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.