AccountId: 011433970860
ContactId: 4369aa96-7549-4706-864d-ea4e7e3466cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 608109 ms
Total Talk Time (AGENT): 192103 ms
Total Talk Time (CUSTOMER): 253273 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/4369aa96-7549-4706-864d-ea4e7e3466cc_20250530T13:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. Um, I have Mr. [PII] on the line. He's already been verified. His policy number is 263.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 33.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 72 and his callback number is [PII] and he needs to um they need benefits for his plan or he's on the phone and we want you to talk to the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Urgent care people.
[AGENT][POSITIVE] Gotcha, [PII]. Thank you.
[CUSTOMER][POSITIVE] OK, thank you. Have a good day, [PII], bye bye.
[AGENT][NEUTRAL] You too bye.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, this is [PII].
[CUSTOMER][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Is this, is this [PII]?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] All right, [PII], so I'm understanding that you're needing me to speak to somebody at an urgent care just to verify your benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK, I'm happy to help. You can put them on the line when you're ready.
[CUSTOMER][NEUTRAL] OK, um, she's in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, give me, she's got a patient in front of me.
[AGENT][POSITIVE] OK, no problem. No worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, the
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi, this is [PII] at American Public Life Insurance. I understand that you need to verify benefits for [PII].
[CUSTOMER][NEUTRAL] Yeah, so, um, do you need our MPI or tax ID?
[AGENT][NEUTRAL] Oh, to see if you're like in network or anything like that?
[CUSTOMER][NEUTRAL] Yeah, cause I did try and run it and um I was coming back as a non-participating insurance and then that the insurance wasn't set up for eligibility, um.
[CUSTOMER][NEUTRAL] So I mentioned to him that he could pay that out of pocket which would be the 125 and then he could take it to you guys and then you might be able to reimburse him, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or, um, depending on if we're in network with you, you know, we can just do that, but I'm pretty sure we don't.
[AGENT][NEUTRAL] OK. I mean, I can check to see if you guys have filed any claims with us before in the past. As far as the members plan goes, it's a limited benefit hospital indemnity plan. So it pays a set amount for the urgent care visit. There's not a network required for usage. It's just a set amount. It's not a percentage or anything.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Yeah, it doesn't make sense.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you still want me to check the ID?
[CUSTOMER][NEUTRAL] Yeah, it's fine. Just that way um I can, I can just make sure.
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, I'm sorry, the phone was breaking out. Will you read that back to me one more time?
[CUSTOMER][NEUTRAL] Yeah, of course. [PII].
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Uh, I'm going to give you back to [PII] really quickly just so I, I can check these couple patients in and then I will be right back, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi there.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] I just can't have the out of pocket at the moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, I mean, I explained to her that like there's not a network required to use the plan, so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because um the only thing I'm trying to do is get my blood pressure medications and when I called the.
[CUSTOMER][NEUTRAL] Urgent care phone number that we have for our our network they need proof or not network but for our insurance they needed proof that I take these medications and it's like, well, might as well go to the doctor because I got the proof of because they didn't wanna take the pharmacy information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] It's a lose-lose for me.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I mean maybe they don't take the insurance here.
[AGENT][NEUTRAL] Yeah, I mean, it's up to them as far as if they're going to accept it, but
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There's not like a specific network with this type of plans, so it's gonna pay, you know, that's what I was explaining to her, it's gonna pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] The standard amount on the plan regardless because it's just like I said it's a limited benefit plan it doesn't require network for usage but.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You like her back or you ready for her back?
[AGENT][NEUTRAL] Yeah, whenever she's ready.
[CUSTOMER][NEUTRAL] Hello. Hi.
[AGENT][NEUTRAL] Hi there. So yeah, I do see that you guys come up as Williams Medical Group, but there's no W9 on file, so there's never been anything filed with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] I can go ahead and.
[AGENT][NEUTRAL] So yeah, I mean, it's up to you guys if you're gonna accept it. I mean I can give you the claims mailing address, payer ID, his effective date and what the plan will pay.
[CUSTOMER][NEUTRAL] OK, yeah, no, um, that should be fine, and then, um, I guess the, the billing department will, will kind of go from there in terms of everything, OK.
[AGENT][NEUTRAL] OK. Um, so his effective date is [PII].
[AGENT][NEUTRAL] Urgent care facility pays $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So would that be under a deductible?
[AGENT][NEUTRAL] So the plan doesn't have a deductible co-pay or co-insurance. The plan just pays $50 towards the urgent care facility visit because it's a limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got it. OK, and then what, what was your name ma'am?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII] spelling.
[AGENT][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] And then can I have the last initial of your last name or the first initial, sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, absolutely. It's [PII].
[CUSTOMER][NEUTRAL] OK, alright, and then can I have a good reference number for this call?
[AGENT][NEUTRAL] Yeah, so a call reference would just be my name with today's date.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 30.
[CUSTOMER][NEUTRAL] And just to verify, um,
[CUSTOMER][NEUTRAL] Do you still want the claim submitted to [PII]?
[AGENT][NEUTRAL] Yep, [PII]. Payer ID is 64556.
[CUSTOMER][NEUTRAL] 45.
[CUSTOMER][POSITIVE] OK perfect sounds good and um.
[CUSTOMER][NEUTRAL] Can I just get a good phone number for you guys?
[AGENT][NEUTRAL] Um, yeah, absolutely. So our number is going to be [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And then it is under American Public Life, correct?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][POSITIVE] Alright perfect I think we should be all set um.
[CUSTOMER][NEUTRAL] If we do have any issues in terms of billing and all that, um, I'm sure someone will be reaching out to you guys, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely, not a problem.
[CUSTOMER][POSITIVE] OK, I hope you have a great day OK?
[AGENT][NEUTRAL] You too. Bye bye.