AccountId: 011433970860
ContactId: 6cb30bdf-efe7-47f4-a6e8-08b6f4617a8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548299 ms
Total Talk Time (AGENT): 207198 ms
Total Talk Time (CUSTOMER): 207522 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/6cb30bdf-efe7-47f4-a6e8-08b6f4617a8b_20250429T15:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Is it [PII] or [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Hi, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] And I am calling from Medren.
[CUSTOMER][NEUTRAL] I am on a recorded line and I was calling um to get to verify eligibility and benefits for patients that we transported.
[AGENT][POSITIVE] Sure, yep, I can check out benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEGATIVE] No extension.
[AGENT][NEUTRAL] Got it. Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number I was given was 023-07927.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I have [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy terminated [PII]. If you'll give me one moment I'll see if you might have one that's active. It could just be a different policy number.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Of course, uh this was for uh medical, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yeah, so that was the last medical policy that he had with us.
[CUSTOMER][NEUTRAL] OK, and it turned on 7124?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, OK, wait, wait, wait, wait, wait, wait. OK. Um, my date of service, evidently this is an older account because our date of service was [PII].
[AGENT][NEUTRAL] OK, yeah, if that's the case then uh there's no timely filing limit, so yeah, as long as it was active, uh, you can still file that claim.
[CUSTOMER][NEUTRAL] OK. Um, can you give me the effective date?
[AGENT][NEUTRAL] Yes, uh, this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] 4123. OK.
[CUSTOMER][NEUTRAL] Um, do you have any benefit information for that account for that policy?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, give me just a moment. I can give you a breakdown. Um, I will say that this is a limited indemnity medical plan, so, um, of course you just pay a set dollar amount per covered procedure or, um, office visit. Bear with me just a moment. Let me get that pulled up.
[AGENT][NEUTRAL] OK, um, of course I will let you know verification of coverage is not a guarantee of payment for claims. Um, what was he seen for on that date of service?
[CUSTOMER][NEUTRAL] OK, so we are an emergency air ambulance.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So he does, uh, or did I guess, um, have a benefit for air ambulance benefits, um, that amount that is $500 max per day for that benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. All right. Um, sorry, I'm just gonna, I have a whole list of stuff I'm supposed to ask, so I'm just gonna back up a second. Um, does this policy have a group number or a group name?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, let me get that for you.
[AGENT][NEUTRAL] So that group number that is 24593.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Group name is Universal Trucking.
[AGENT][NEUTRAL] Transworth, that's T R A N S W O R T H.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] What did that already did that. Um, does he have any deductibles or out of pockets?
[AGENT][NEUTRAL] No, as this policy was a like limited indemnity, um, it's not like traditional, uh, major medical, so no co-pays, no deductibles, um, no authorization required, nothing like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No copay, no deductible, no out of pocket, and no co-insurance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is this, OK, I know you, I don't know a lot about, um, what the limited indemnity plan is. Is that an HIE plan?
[AGENT][NEUTRAL] You're fine.
[AGENT][NEUTRAL] No, um, again it's just essentially what it means is it's um that set dollar amount and it is limited as to what is and is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a bit different.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Um, is that a
[CUSTOMER][NEUTRAL] A self or fully funded policy.
[AGENT][NEUTRAL] It was through his employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said there's no limit on the timely filing?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No limit.
[CUSTOMER][NEUTRAL] Do you happen to know?
[AGENT][NEUTRAL] And I do have a mailing address, fax number and a payer ID if you'd like any of that information.
[CUSTOMER][NEUTRAL] Um, yeah, let me, let me.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] Let me pull up my, I have a payer listed in my.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In my system that I wanna verify that information, so yeah, OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] All right, I'm ready.
[AGENT][NEUTRAL] OK, um, um, did you want me to just start with the mailing address? Did you want all of the information?
[CUSTOMER][POSITIVE] Yeah, please, that would be awesome.
[AGENT][NEUTRAL] OK, sure, so mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then that fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that payer ID is 60801.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] All right, let's see if they even have that in here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, they don't. OK, now do you know who that payer ID is through?
[AGENT][NEUTRAL] Oh, that's through us. It's APL.
[CUSTOMER][NEUTRAL] Like what's we.
[CUSTOMER][NEUTRAL] OK. All right. That might be why because we use uh resetto.
[CUSTOMER][NEUTRAL] So I don't know. I don't know enough about that. I just know that we use Corvetto.
[AGENT][NEUTRAL] OK, I'm not really familiar with all that either.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, um, all right, now I got that, I got that.
[CUSTOMER][NEUTRAL] Oh, last question.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I'm so sorry. I gotta clean my throat.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does this policy have a third-party administrator?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] OK, no TPA. Awesome. And I lied, that was not the last question. Do you happen to have a call reference number?
[AGENT][NEUTRAL] Sure, uh, that would, it's totally fine. Um, that would be my first name, last initial, and today's date, uh, so my last initial is [PII], and was there anything else I can help you, you know?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, no, I believe that's it. Oh shoot.
[AGENT][POSITIVE] OK, alright, no worries, yeah, well, well, thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Same to you. Thank you. All right. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.