AccountId: 011433970860
ContactId: 649ca989-9176-4cfb-b3b7-30ce74adb5e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1194510 ms
Total Talk Time (AGENT): 362255 ms
Total Talk Time (CUSTOMER): 423187 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/649ca989-9176-4cfb-b3b7-30ce74adb5e0_20250102T13:06_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Cyprus Great Outpatient Surgical Center. I have a member here who's scheduled to have a procedure done. I just wanted to verify um coverage with you guys if possible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um, give me one quick second. Let me see if he has 11 moment.
[CUSTOMER][NEUTRAL] What the
[CUSTOMER][NEUTRAL] OK, sorry about that. So I'm not quite sure if he has a um policy number as of yet, but I can, I do have his first and last name and date of birth if that helps.
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][POSITIVE] Oh, I can, I can get it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, give me 1 2nd.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me 1 2nd, I'm gonna have him give it to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright so I have on the phone and they're just asking for your OK, hello.
[AGENT][NEUTRAL] Good morning. This is [PII] with [PII]. Your name?
[CUSTOMER][NEUTRAL] How are you? My name is [PII].
[AGENT][POSITIVE] I'm good.
[AGENT][NEUTRAL] OK, [PII], let me search for your policy number by your social.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and when did you become effective?
[CUSTOMER][NEUTRAL] Uh, the [PII].
[CUSTOMER][NEUTRAL] [PII], so just recently, and I think that's probably the problem.
[AGENT][NEUTRAL] And who is your employer?
[CUSTOMER][NEUTRAL] Uh, poly Level USA.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] P O L Y.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You might have it as Polylift USA.
[AGENT][NEUTRAL] Poly left.
[AGENT][NEUTRAL] I'm not showing it under either group name POLY is it two words or just one?
[CUSTOMER][NEUTRAL] Two words.
[AGENT][NEUTRAL] So [PII], there's nothing under that.
[CUSTOMER][NEUTRAL] No, no, no, [PII]
[AGENT][NEUTRAL] That's what I'm typing, [PII] There's nothing under that name and what was the other name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It would either be poly Level, [PII]
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] I'm not finding anything, anything under that name for the group.
[AGENT][NEUTRAL] Could it be under anything else?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me look at something here.
[AGENT][NEUTRAL] Did they give you any type of paperwork?
[CUSTOMER][NEUTRAL] Uh, I just have my.
[AGENT][NEUTRAL] When you enrolled?
[CUSTOMER][NEUTRAL] My benefits and enrollment confirmation.
[AGENT][NEUTRAL] And who did you receive that from? What's the name on the confirmation?
[CUSTOMER][NEUTRAL] But that's more a
[CUSTOMER][NEUTRAL] It's from Ease is the name of the ease is the the uh.
[CUSTOMER][NEUTRAL] I guess the portal that they use, it's Dennis Charlie Insurance.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] I'm not finding anything.
[AGENT][NEUTRAL] Is there a phone number on the confirmation that you received?
[CUSTOMER][NEUTRAL] Mm, no, it just says carrier American Public Life plan American Public Life APL effective date [PII] and then it shows uh all my family members and that's really it.
[AGENT][NEUTRAL] So the effective date is [PII] and so did you enroll on the [PII]?
[CUSTOMER][NEUTRAL] Yeah, I enrolled on Friday, and I think that's part of the problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I think so because I'm not showing the group. Do you know who enrolled you?
[CUSTOMER][NEUTRAL] It's just so new.
[CUSTOMER][NEUTRAL] Cause
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Myself
[AGENT][NEUTRAL] Oh, you enrolled.
[CUSTOMER][NEUTRAL] Yeah, so we get a link through the employer and we have to go in and do our insurance elections.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there any way you can reach out to that entity when you that you call your employer?
[CUSTOMER][NEUTRAL] I've, I've already have. I did that on Friday and asked them to escalate this and told them it's pretty urgent that I have this in place.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, it shows processed.
[AGENT][NEUTRAL] Yeah, I'm not showing the enrollment. I'm not showing anything under 590584905. Uh, [PII], spell your last name. Let me search by your name as well.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what state do you reside?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Seeing anything under your name.
[AGENT][NEUTRAL] And you said that they gave you a link. Do you know what platform that was when you clicked on that link?
[CUSTOMER][POSITIVE] Uh ease benefits.
[AGENT][NEUTRAL] Spell Es.
[CUSTOMER][NEUTRAL] Where you go in and you kind of
[CUSTOMER][NEUTRAL] E A S E
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Benefit mall partner account. It shows processed on my end.
[AGENT][NEUTRAL] Be a bit more.
[CUSTOMER][NEUTRAL] Gap medical enrolled uh.
[CUSTOMER][NEUTRAL] He signed on [PII].
[AGENT][NEUTRAL] I'm familiar.
[CUSTOMER][NEUTRAL] Process by Benefit Mall partner account. Benefit Mall is the general agent of this carrier. Notification was sent to the broker.
[CUSTOMER][NEUTRAL] That this transaction has now been completed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] And uh like I said it shows.
[CUSTOMER][NEUTRAL] All my family members, the carriers, American Public Life, the plan has ga Medical APL [PII].
[CUSTOMER][NEUTRAL] That says enrolled [PII].
[CUSTOMER][NEUTRAL] And the document was e-signed and stamped dated [PII].
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, OK? Give me one moment I'll be right back with you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Conferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] Hey [PII].
[AGENT][NEUTRAL] Um, hi, I have a provider on the phone trying to verify benefits. She put the insured on the phone and he just recently enrolled through Benefit Mall.
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm looking at the guru article.
[AGENT][NEUTRAL] Um, do you know who the file is sent to when they enroll online?
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] I have no well it would be sent probably to [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The enrollment team? I don't know if any of them are on right now.
[AGENT][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] Um, well,
[CUSTOMER][NEUTRAL] [PII] is on.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] She is, let me look for her.
[CUSTOMER][NEUTRAL] What group is it?
[AGENT][NEUTRAL] All he has is Benefit Mall. Um, I believe he said something like poly lift or he said it could be polylevel, P O L Y.
[AGENT][NEUTRAL] And then fin[PII] reference to benefit mall.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, we have, yes, we have a poly-level, AKA poly lift.
[AGENT][NEUTRAL] And he said it was.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you have a group number?
[CUSTOMER][NEUTRAL] Not let me see if they've gotten it yet.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] Let me see when this was sent over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], I'm not seeing any notes. I mean.
[AGENT][NEUTRAL] OK, I'm gonna send [PII] um.
[AGENT][NEUTRAL] A message.
[CUSTOMER][NEUTRAL] Let me see if we've even gotten the new business forms.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] We don't even have the bouncer app.
[AGENT][NEGATIVE] This puts us in such an awkward position when we take these calls.
[AGENT][NEUTRAL] I mean, me telling him, you know, he received the confirmation and then, you know, it's just a difficult situation, always.
[CUSTOMER][NEUTRAL] Yeah, I.
[CUSTOMER][NEUTRAL] What I would say is.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Yeah, it puts us in an awkward position too, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just let them know that we haven't processed the file yet, which is a true statement.
[AGENT][NEUTRAL] Or the file was in, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I'm gonna have.
[CUSTOMER][NEUTRAL] Or we reach out to the broker.
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Yeah, you have Charlie Insurance?
[AGENT][NEUTRAL] Something like that.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] is the broker. Yeah.
[AGENT][NEUTRAL] [PII]. I can't read my own handwriting. Yeah, [PII] Charlie uh Insurances, he did reference his name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see because that name is not familiar, although I don't deal with Florida that much but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, if he's even appointed.
[CUSTOMER][NEUTRAL] Yeah, he's appointed.
[CUSTOMER][NEUTRAL] Yeah, we'll reach out to him this morning but um.
[CUSTOMER][NEUTRAL] You see if they can just call back just let them know that.
[CUSTOMER][NEUTRAL] You're in processing we just haven't gotten it processed yet and we'll see if.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We can hustle and get this.
[CUSTOMER][NEUTRAL] Group processed after we get the master app.
[AGENT][POSITIVE] All [PII]. OK.
[CUSTOMER][NEUTRAL] OK, sorry, I didn't have any better answers for you.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Uh-huh, bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] [PII], thank you so much for holding. I just spoke with our broker resources uh department and they're going to reach out to to [PII]. um, we've not received that file yet.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Um, it being it being the.
[CUSTOMER][POSITIVE] Alrighty, so
[AGENT][NEUTRAL] Oh, he's gone.
[CUSTOMER][NEUTRAL] Yeah, yeah, but he's, um, he had to actually get, um, the patient registered, so I just kind of took over the call back again already you were saying what now? I'm sorry, what's your name? I didn't quite catch that at the beginning. I'm sorry. Hi.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII]. It's [PII]
[CUSTOMER][NEUTRAL] Alrighty, [PII], my name's [PII], by the way.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alrighty, you were saying what now? I'm sorry?
[AGENT][NEUTRAL] Uh, so is there any way that I could speak with him? or you said he's getting registered?
[CUSTOMER][NEUTRAL] Yeah, the son is getting registered.
[AGENT][NEUTRAL] OK, so we do not have the enrollment information at this time since it he just recently enrolled, um, so our broker resources team is going to reach out, uh, he gave a name which is actually the agent or the broker, uh, they're going to reach out to um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That entity uh for the enrollment information we've not received it yet.
[CUSTOMER][NEUTRAL] Now typically, do you know what the turnaround time would be if someone was to enroll in a policy or a plan for you guys? like what the turnaround time?
[AGENT][NEUTRAL] I, I mean, that's not my area and it depends once we receive it, I I really don't know cause that's not my area, um, and being that we don't have it, um, he just like he stated, recently enrolled and we're waiting on the file to get it entered, um.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You know, and his policy number assigned.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So if you could let Mr. [PII] uh let uh [PII] know uh that we're reaching out to the broker and gonna try to expedite this as quickly as possible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and [PII], would you happen to know anything about, um, just asking because I'm I'm not sure if you know, but do you happen to know if, if there are any fees or anything that he would pay today and let's say everything gets finalized, what are you guys' like reimbursement process? Would you guys be able to reimburse him directly once the.
[AGENT][NEUTRAL] Well, of course, I can't, I, I can't verify the benefits because I don't know what type of policy he has, um, and I think I heard him say that it was a medical gap policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Correct, I did see the documentation that said it's a gap medical policy.
[AGENT][NEUTRAL] OK, and so this policy would be secondary to the primary insurance, um, and for outpatient we'll usually reimburse, um, depending on his benefits, anything, any amounts applied towards his calendar year deductible, uh, co-insurance and or copay amounts up to whatever the policy benefit maximum is.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Deductible and stuff like that, OK.
[CUSTOMER][NEUTRAL] OK. Alrighty, um, now,
[CUSTOMER][NEUTRAL] As far as reimbursement process, that would go directly back to him, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, generally, um.
[AGENT][NEUTRAL] If, if he's paying out of pocket, um, he can be reimbursed.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, but he would have to submit the documentation or the provider can submit the the documentation, you know, for him after submitting it to the major medical carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so usually what we can do, we can um send all the information over once we receive like his um policy number and things like that and and we can place it into the system and we can send it off to you guys like um any type of medical claims to whatever PO box that you guys could have that would just be the only thing that we can do it on our end for him but we just have to get his member ID and things like that once he has it right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number
[AGENT][NEUTRAL] Mhm. Absolutely, totally get that. Yeah, and, um, so generally, excuse me, uh, when we process the claim, it is reimbursed back to the provider, providing there's an assignment of benefit on file, and they generally don't have to pay anything out of pocket because their policy usually picks up deductible, co-insurance and or co-pay amounts, but unfortunately, and I apologize, I can't verify what those benefits are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, and that's understandable.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty. Well, I thank you so much for your assistance today there, [PII].
[AGENT][NEUTRAL] All right, [PII]. Any other questions?
[CUSTOMER][POSITIVE] Do you have any questions for him? Nope, that's everything. We appreciate you. Thank you.
[AGENT][POSITIVE] OK, you're welcome. Thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Alrighty bye bye mhm bye.