AccountId: 011433970860
ContactId: 5d7b4746-ab65-49b4-bc36-9e61c87f8085
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429220 ms
Total Talk Time (AGENT): 194045 ms
Total Talk Time (CUSTOMER): 163951 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/5d7b4746-ab65-49b4-bc36-9e61c87f8085_20250123T20:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from JPS Wataga, and I'm trying to get, um, see if this patient that's trying to be seen today is in network.
[AGENT][NEUTRAL] OK, can I get a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, and you said [PII], right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, it's gonna be [PII].
[AGENT][NEUTRAL] was it [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII], you can put [PII] mhm, no problem.
[AGENT][NEUTRAL] [PII], OK, I was like, let me make sure I heard that right. OK, um, do you have the policy number for your patient?
[CUSTOMER][NEUTRAL] Yes, let me see we have policy it's gonna be 02505608.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK, can you verify their name and date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII], date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this is a limited benefit hospital indemnity plan. Um, there's not really a network per se for these plans. Um, let me look at their card on file.
[CUSTOMER][NEUTRAL] OK, and I can give you, uh, uh, NPI so you can tell me if you guys in network because she said she's used before at Baylor Scott and what else you said?
[CUSTOMER][NEUTRAL] And Texas Health because we are a county uh hospital um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, Tarrant County JPS Watauga.
[AGENT][NEUTRAL] So like I said this is an indemnity plan so there's not really like an in network out of network they can go and see whoever they want their benefits are set, um, it's not going to matter. The difference is, um, if they see a provider within the multi plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Network that may benefit them as far as what they may owe after we've paid because you know it's like repriced and.
[AGENT][NEGATIVE] That way, but as far as what we pay, it's not gonna make a difference who they see.
[CUSTOMER][NEUTRAL] OK, so are you able to look at by MPI to see if we're in the multi-plan network?
[AGENT][NEUTRAL] If you're in the multi-plan?
[CUSTOMER][NEUTRAL] Yeah, if we're part of that multiplan network.
[AGENT][NEUTRAL] Um, possibly let's see if I can get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if you have her chart up, can I get her a deductible and her max out of pocket and coinsurance if there're any?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so find a provider.
[AGENT][NEUTRAL] See if it gives me the option of putting in the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the name will be called, so it's not American Public Life it will be called um multi plans if I put it in with it, should I do is American Public Life or should I do multipla multi plan insurance?
[AGENT][NEUTRAL] Uh, you would do American Public Law. No, you would do American public, yeah.
[CUSTOMER][NEUTRAL] A mother payroll OK.
[AGENT][NEUTRAL] OK, what's your MPI number?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] I'm sorry I lost you for a minute. I don't know if it was my phone or yours.
[CUSTOMER][NEUTRAL] Yeah, sound like it's breaking up some it's [PII] so it's [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect. OK, let me see.
[AGENT][NEUTRAL] And what city is um is that in?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And you still live on [PII]? OK.
[AGENT][NEUTRAL] OK, let's see, it is searching.
[AGENT][NEUTRAL] And it's JPS Health Center Wataga.
[CUSTOMER][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] OK, um, it does show that you all are within the multiplan network.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK perfect so we are in network, OK.
[AGENT][NEUTRAL] Mhm and then for her you said deductible and like out of pocket and everything?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. So there is no deductible for this plan?
[CUSTOMER][MIXED] OK, no deductible.
[AGENT][NEUTRAL] Um, no copay.
[AGENT][NEUTRAL] None of that.
[CUSTOMER][NEUTRAL] When we don't do copays, we just do because we're hospital based so it'd be deductibles maxed out of pocket the co-insurance. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, um, so with this not being major medical and being an indemnity plan there's not gonna be like a max out of pocket for us or anything like that. Now there is a limit as to what we will pay for certain benefits, but there is not a max out of pocket listed for the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Insured or the patient.
[CUSTOMER][NEUTRAL] OK, and what about co-insurance?
[AGENT][NEUTRAL] That's not part of our plans either.
[CUSTOMER][NEUTRAL] Not part of OK, so no, so nothing. OK, Hospital indemnity and what is the group number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] Um, that is gonna be 70083.
[CUSTOMER][NEUTRAL] OK, I'm sorry, 783?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And you said the group name is called American Public Life?
[AGENT][NEUTRAL] So that's gonna be the company name. The group is Lark LLC, and that's doing businesses or DBA on track staffing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] businesses or DBA.
[CUSTOMER][NEUTRAL] On track is it track TRIC or TRICK?
[AGENT][NEUTRAL] T R A C K.
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] T R A C K.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so I have LLC D B A 00 N T R A C K staffing.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then the claim address I have, I'll make sure I have what it shows here. It shows me submit claims to attention IMA and Corp [PII] [PII] I guess that's [PII] and the EDI pairer. OK, perfect. And what's your call reference number? Can I get a call reference number, [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It would just be my name so you could use [PII] and today's date.
[CUSTOMER][POSITIVE] And today's date and today's date is the [PII]. Alright, alright, awesome, thank you so much, appreciate it.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] You're very welcome. Have a great day, [PII].
[CUSTOMER][NEUTRAL] You do the same bye bye.
[AGENT][POSITIVE] Thanks bye bye.