AccountId: 011433970860
ContactId: 2664dca2-4ff8-40f1-b9de-dcc2f9f41b04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 811539 ms
Total Talk Time (AGENT): 162066 ms
Total Talk Time (CUSTOMER): 138913 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/2664dca2-4ff8-40f1-b9de-dcc2f9f41b04_20250421T20:34_UTC.wav
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[AGENT][NEUTRAL] Hello, this is is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII]. I am with [PII]. I was calling to check to see if a patient has um insurance with y'all.
[AGENT][NEUTRAL] Yeah, of course. Um, what is the patient's first and last name?
[CUSTOMER][NEUTRAL] This is for [PII]
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, just one moment while my computer thinks.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And then can you verify [PII]'s date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like she has multiple policies with us.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And they're all active. Uh, she has a hospital indemnity plan.
[AGENT][NEUTRAL] Uh, disability plan.
[AGENT][NEUTRAL] A dental plan.
[AGENT][NEUTRAL] Let's see, and then 2 more.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Which one would she have for uh medical benefits for urgent care?
[AGENT][NEUTRAL] Let's see, that would probably be the HI one. There's two other ones. Let me see what those ones are really quick.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] So this is how I found, I found your numbers. Uh, she provided us with a dental card for PHCS for 90 degree benefits, so we filed that it got rejected when I just reached out to PHCS they're like, no, we don't, we don't have that patient just for dental and vision. So I saw where the patient was seen by us in [PII], and when I pulled the EOB for it, it, it just gives a payment by APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I really don't have nothing else to go off of.
[AGENT][NEUTRAL] Oh, OK, I see. Uh, she has two other policies. Let me see what those ones are.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. So she has a term life policy, which it wouldn't be that one, and the group accident policy.
[CUSTOMER][NEUTRAL] So is the group accident cover urgent care?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Let me just put you on a brief hold while I look into, I'll look into the group accident one and then the hospital indemnity as well.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] And yeah, you're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 921
[AGENT][NEUTRAL] right
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 45.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, are you there?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, just give me a couple more moments. I'm just reading through this policy really quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thanks for holding um so is this a physician's office?
[CUSTOMER][NEUTRAL] Um, it's a facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The file is an urgent care as a group.
[AGENT][NEUTRAL] Oh, OK, I see. So it looks like.
[AGENT][POSITIVE] Your best option for urgent care.
[AGENT][NEUTRAL] Would be the hospital indemnity plan.
[AGENT][NEUTRAL] Um, it looks like.
[CUSTOMER][NEUTRAL] And who who is that with?
[AGENT][NEUTRAL] On.
[AGENT][NEUTRAL] Let's see, sorry, I have both of them pulled up so it's like going back and forth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the group name is Crown Services Inc DBA Crown Staffing.
[CUSTOMER][NEUTRAL] Does it have a payer ID?
[AGENT][NEUTRAL] No, it has a group number.
[CUSTOMER][NEUTRAL] OK, what's the group number?
[AGENT][NEUTRAL] 70036.
[CUSTOMER][NEUTRAL] Crown services is that their employer?
[AGENT][NEUTRAL] Yes, it's through an employer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, who do you know who the CPA for them for this employer would be or somebody that I could contact where the claims need to be billed to?
[AGENT][NEUTRAL] Yeah, just a moment, let me look that up for you. Let's see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So if you're sending a claim or an EOB you can send it to us.
[CUSTOMER][NEUTRAL] OK, do you have an electronic payer ID?
[AGENT][NEUTRAL] Yeah, um, let me give that to you.
[CUSTOMER][NEUTRAL] I give you that [PII].
[AGENT][NEUTRAL] OK, so our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, can I get a reference number? Oh wait, one more thing, can, do you have a member ID? I got the group. Do you got the member ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I, I believe I have it. I believe it's, um, starts with a 002455921, but I just want to double check.
[AGENT][NEUTRAL] OK, yes, for this one, you're correct. 245-592-1. Mhm.
[CUSTOMER][NEUTRAL] OK, uh, do I put the 0 in front or without the 0?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, without the 0.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get um a reference number and that's all I'll need.
[AGENT][NEUTRAL] Yeah, of course. It's [PII], my last initial [PII] and then today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you, have a good day.
[AGENT][POSITIVE] Yeah, thanks for calling APO. Have a great day.
[CUSTOMER][NEUTRAL] Bye.