AccountId: 011433970860
ContactId: 3776c7ef-9515-4ebc-ba67-b4f58499a6c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 583200 ms
Total Talk Time (AGENT): 252614 ms
Total Talk Time (CUSTOMER): 197497 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/3776c7ef-9515-4ebc-ba67-b4f58499a6c9_20250121T19:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. May I help you?
[CUSTOMER][NEUTRAL] May I help you? Um, yeah, I have a couple of questions.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with your questions. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. My phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, yeah, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm thinking it's 0235.
[CUSTOMER][NEUTRAL] 1181.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said 235-1185?
[CUSTOMER][NEUTRAL] Um, I'm looking at an old picture that it may be different. I don't know.
[AGENT][NEUTRAL] What's the name on the policy?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, that's you or you're in a relation to the page to the insured?
[CUSTOMER][NEUTRAL] Oh, that's me.
[AGENT][NEUTRAL] OK, so can you verify your date of birth and your mailing and email address on file?
[CUSTOMER][NEUTRAL] Um, the date of birth is [PII] and the email is [PII] made [PII].
[AGENT][NEUTRAL] OK, and your mailing address.
[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 yes, that was the correct policy number. And how may I assist you today?
[CUSTOMER][POSITIVE] Oh yeah, that was the correct.
[CUSTOMER][NEUTRAL] Um, the family doctor that I have been going to, y'all have been covering it, but, uh,
[CUSTOMER][NEUTRAL] They told me the last time I was there that um it wasn't working and I wanted to figure out why.
[AGENT][NEGATIVE] It wasn't working. OK, let me see.
[AGENT][NEUTRAL] So there's a, is this a Coney Memorial Hospital or would it be something else?
[CUSTOMER][NEUTRAL] No, no, it's something else. It's uh.
[CUSTOMER][NEUTRAL] It's Prisma Prisma Health Mountain Lakes.
[AGENT][NEUTRAL] Mountain lakes, OK, hold on one second. Is mountain lakes in upstate the same thing, or am I looking for mountain lakes?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um, it just says Pris of Health Mountain Lakes Family Medicine. It was [PII].
[AGENT][NEUTRAL] [PII] or earlier?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah and there was they said that um there was a couple that.
[CUSTOMER][NEUTRAL] I have a bill for 2 visits.
[AGENT][NEUTRAL] OK, so we don't have any claims on file for [PII], so they just need to file the claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] File a claim.
[AGENT][NEUTRAL] Let me make sure the policy was active. Yeah, your policy has been active since [PII]. So they can file the claim at any time, but when I put that data service in here, there it is literally blank, like there's no claims for that day.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, can, um, can you explain to me like on 5, how to tell them to do that?
[AGENT][NEUTRAL] Oh, sure. Um, so either, um, hold on, let me get to it.
[AGENT][NEUTRAL] They can either mail it to us or they can send it electronically.
[AGENT][NEUTRAL] So if they mail it, um, I can give you the address. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's going to [PII].
[AGENT][NEUTRAL] Which is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], uh, which is [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] Or they can send it electronically.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can let them know the payer ID.
[AGENT][NEUTRAL] It's 64.
[AGENT][NEUTRAL] 556.
[CUSTOMER][NEUTRAL] OK, so one more question, a guy I talked to sometime last time, uh, not last time, but last year said that um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The number, the card would never change, is that correct?
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] OK, because um they keep for some reason they keep asking for it every time I go so I don't know.
[CUSTOMER][NEUTRAL] If that's uh a them issue.
[AGENT][NEUTRAL] I don't know, maybe they're not saving it. The best thing to do is when you give them a call, I will give them our phone number as well and have them give us a call. Um, providers call all the time, we'll just need your first and last name and date of birth and then that policy number, and we can um go through the policy with them, how to file a claim, you know, help them however they need help, but they're, they're definitely not filing the claim.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I was gonna ask one more thing, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So basically y'all are paying for the visit, right?
[AGENT][NEUTRAL] Well, I mean, yes, you have claims on here that have been paid.
[AGENT][NEUTRAL] I don't know, I, I don't see any from the, the location we were just looking for, but yes, you have like the one upstate that I was looking at. I didn't know, you know, if that was the same location, but yes, you have paid claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but I'm just wondering because like I said they have, they said I had two visits that that weren't being uh paid for I don't know.
[AGENT][NEUTRAL] Well, [PII], was there another day or they were both for [PII]?
[CUSTOMER][NEUTRAL] Um, there was another day they didn't give me the exact date for the other one, but I know that just when I went for the [PII] they said that um.
[CUSTOMER][NEGATIVE] Basically they told me that they would let me be seen and not make me pay the 150 copay or whatever it was I can't remember.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Whoa, wait a minute.
[CUSTOMER][NEUTRAL] But um,
[AGENT][NEUTRAL] Do you have another type of insurance?
[CUSTOMER][NEUTRAL] No, I'll just have your.
[AGENT][NEUTRAL] OK, so hold on one second.
[AGENT][NEUTRAL] Is that a co-pay that they're making you pay for their location, because your policy doesn't have a copay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Honestly I don't even know what they're I don't even know what they're talking about because like I said like I've I've never I've been going to that doctor for like.
[CUSTOMER][POSITIVE] Probably 2 years more and uh I've always used y'all and I've never had to pay. They just come out the other day and told me that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Something was wrong and whatever.
[AGENT][NEUTRAL] I'm wondering
[AGENT][NEUTRAL] Sometimes when a loca provider doesn't, can't locate the um insurance in their system like you know how they verify before you come in, they'll apply like a self-pay fee, um, or like a just to if there are charges that are incurred, the $150 will be applied to it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I will have them definitely give us a phone call and so that we can verify benefits with you uh with them.
[AGENT][NEUTRAL] And um help them with filing the claim because
[AGENT][NEUTRAL] Uh, unless they're doing something for the facility, there, there's no copay on a hospital indemnity, uh, policy. Sometimes they have deductibles, but
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] There's no deductible on this policy.
[CUSTOMER][NEUTRAL] OK, um, could you, could you email a copy of my cards to me because, uh, and also send some in the mail.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] And I think that'll be it. I'll call him when I get off the phone with you.
[AGENT][NEUTRAL] OK, and OK, so you need the ID cards emailed and mailed to you, so I put in that request in for you now. And was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it I think.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL [PII]. I hope you have a good day and if you need it, just give us a call. I'm the only [PII] here.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] What can I file?
[AGENT][POSITIVE] You're welcome. Bye