AccountId: 011433970860
ContactId: 78fbf496-85fe-47bf-bd9f-fbd52dd0d364
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749750 ms
Total Talk Time (AGENT): 269414 ms
Total Talk Time (CUSTOMER): 424961 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/78fbf496-85fe-47bf-bd9f-fbd52dd0d364_20250506T20:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII]. I'm calling to verify insurance please.
[AGENT][NEUTRAL] OK, [PII], are you needing only eligibility or eligibility and benefits?
[CUSTOMER][NEUTRAL] I need eligibility and I mean just eligibility and if they have a copay.
[AGENT][NEUTRAL] I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 6077.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] So, the card that is scanned in, it looks like it's D43.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] Whoops, I'm sorry, there's, OK. Now that number indicates that they have a policy with 90 degree benefits for APL it should have a different number because I can't pull their information with that number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the AP APL number that he gave me, which is so let me ask you a question, so you, what is it called to get APL?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] A as in A NPL so the policy number that looks like he gave was 2294497.
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Then what part is this?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and [PII], any information that I provide will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] His last name is [PII]. So the first name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He's a junior. His date of birth is [PII].
[AGENT][POSITIVE] Uh, thank you for the information, just a moment.
[AGENT][NEUTRAL] OK, bear with me just a moment please, um, and let me look at one thing.
[CUSTOMER][NEUTRAL] OK, so the card that he gave you, where did you get that card from? Because this is not the same, the card that he gave his 90 degrees. She's saying it's [PII].
[CUSTOMER][MIXED] Yeah, I don't think that's up to date. Yeah, but I think that's the car that the mom has. That's not the right car. Oh yeah, that looks nice.
[CUSTOMER][NEUTRAL] So I had him earlier and when I called them they said that it was only preventative and wellness. He got a he got a um so it's.
[AGENT][NEUTRAL] OK, [PII], just bear with me a couple of minutes, but if you don't mind, um, I've got to have someone to, to do something for me. So if you don't mind bearing with me just one second, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright. So, obviously, mhm, so obviously the card that he, the dad called, well, I called it, no, but obviously the card, the dad, the one dad called is called APL. This is saying 90 degrees, so it's totally two different, two different listening.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Because I'm, I'm on the phone with the lady now and she's, I'm I gave her the ID number, she said that's 90 degrees, so I, I really don't know.
[CUSTOMER][NEUTRAL] And the thing with it is is that are you able to get in contact with that and tell him to send you that card, a picture of that card?
[CUSTOMER][NEUTRAL] Just to make sure it's not the same card.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, I just need to, I, I'm actually gonna need the card because of the fact of the matter if he has the card or however he thought was able to call, he should have a copy of the card.
[CUSTOMER][NEUTRAL] You can ask me questions you need to ask you to send um.
[CUSTOMER][NEUTRAL] I'm [PII]. Hi, my name is [PII]. I'm calling from Cooper Urgent Care and I'm calling about your son, your junior. So the card that you, um, the card that the, the grandpa has, is a, is a 90 degree card. I'm on the phone with the lady that I guess you called. What, what, what's name is that the name of that insurance?
[CUSTOMER][NEUTRAL] Do you have that card on you?
[CUSTOMER][NEUTRAL] No, they, they sent me one card.
[CUSTOMER][NEUTRAL] Yeah, I understand that, but the thing with this is that no matter what, I'm just, um, my shift is just starting, so no matter what, I still have to call it in, but the card that that the grandpa has is a 90 degree 9090 degree card it's not an APL card. [PII], the information that I gave right the number you have to call.
[CUSTOMER][NEUTRAL] I have been. I'm actually on the phone with the lady now, but what I'm trying to say is for to to to so that this won't go on for on as long you have this insurance, do you have a copy of that card?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Like, where did you get that number from? because that number is no longer on.
[CUSTOMER][NEUTRAL] 2 for you guys to sort it out because my son is [PII]. I don't understand how there's the difference between.
[CUSTOMER][NEGATIVE] What is it, but there's no there is no.
[CUSTOMER][NEGATIVE] Yeah, we're what, what I'm saying to you is the, the, the thing with it is is that this is not because this is not an emergency room we have to verify the insurance before we sit up here and literally for him to be seen. I am, I'm on the phone with them now, but you're literally sitting up here telling me what the card is saying is not what the what is not what the billing address is saying. So no matter what the bill can get kicked back because it's APL.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] The car with the car with the bill with is it yes, that's what I'm saying to you. I'm not trying to be rude or nothing like that. I'm on the phone with the lady now. Can I help? What, what did you say, ma'am?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm still here.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] So I, I don't wanna do you want me to wait until, OK.
[CUSTOMER][NEUTRAL] I right.
[CUSTOMER][NEUTRAL] You can go ahead. No, you can go ahead. You, [PII], I'm on the phone with her now. I just finished talking to her. Thank you. No, because I'm actually on, uh, it doesn't work like that. Go ahead, you can say what you're saying, ma'am. You can go ahead and say what you're about to say.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, so this child is on this limited benefit plan. The policy is showing as active [PII], and the effective date on it is one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Again, it is showing
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] Uh-huh. Actually, the child, let me look at the child's affected. Just one second.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm sorry, while you were talking to him, I went to a different screen, so I'm sorry, bear with me just one second.
[CUSTOMER][NEUTRAL] That's OK. I'm just trying to understand the way it is because the card that Grandpa has it like you said when I gave you that policy number it came up with 90 degrees. So my thing is that now it's supposed to be billed through APL, so I'm gonna need a billing address for that.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Uh, and I'll, I'll, I can give you that. Now, on his, on that, do you have a copy of that ID card that has the, that medical ID number on there?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We can
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] That the number.
[CUSTOMER][NEUTRAL] Yeah, the one that starts with a [PII] Yes.
[AGENT][NEUTRAL] Uh-huh. All right. Is it [PII], is that what you said? Or?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so on the ID card that has all of the correct information, it should say APL in the upper left hand corner.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then it should have his group name, his name, the coverage type, policy cert number, which is that 02294497 number.
[CUSTOMER][NEUTRAL] In or out?
[CUSTOMER][NEGATIVE] Yeah, that's not, that's not the part that they have given me.
[AGENT][NEUTRAL] Uh, OK. All right, so this, yeah.
[CUSTOMER][NEUTRAL] And that's what I was trying to explain to him. I was just saying if he has the card, you can send it over to me because it, it, it's, it's conflicting with the billing, but OK.
[AGENT][POSITIVE] Yeah, and I can provide you.
[CUSTOMER][NEUTRAL] Uh, I'm just, I'm just, I'm gonna get it from, I'm just gonna get it from you and then, I mean, I'm just doing my best to try to sit up and get the kids started my shift just started, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, I understand. OK, so the policy is active. This plan has an effective date of [PII]. And then what type of benefit information first off, do you need for him or do you even need benefit information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So he's here seen at the urgent care. Is he eligible to be seen at the urgent care?
[AGENT][NEUTRAL] OK, let me see about benefits on this limited benefit plan for urgent care.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, the next one is exposure. That is if you come into contact with any body fluid or blood, and you a detect the injury.
[CUSTOMER][NEUTRAL] OK, the next one is HIPAA.
[CUSTOMER][NEUTRAL] Um, is your right
[AGENT][NEUTRAL] OK, so on this limited benefit plan, there is an outpatient sickness writer, and again, any information that I provide for you, [PII] is a verification of benefits and not a guarantee of payment. But for an office visit, the maximum benefit per visit is $75 and a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I literally didn't even.
[CUSTOMER][NEUTRAL] What brings you in?
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Now on this um now for claims on this particular policy, the claims are sent to IMA they go to their clearing house.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's it called IMA.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I am a.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the claim's mailing address is going to be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Egan, which is [PII]. Payer ID is 64556.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And then once the claim has been received and processed here by APL we do have a portal Roel that you should be able to check the claim status in.
[CUSTOMER][NEGATIVE] get bumped up.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] And the website for the portal for us is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And what's your name?
[AGENT][NEUTRAL] All right. Again, my name is [PII] and you would use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] My name
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] See, actually, I spell it [PII]
[CUSTOMER][POSITIVE] Thank you, Ms. [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome and thank you again for calling APL and I hope you have a very nice evening.
[CUSTOMER][POSITIVE] Thank you, you too. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye bye.
[CUSTOMER][NEUTRAL] And we'll bring