AccountId: 011433970860
ContactId: 7943b1fd-f931-489e-ba34-1639fe950f56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375279 ms
Total Talk Time (AGENT): 201904 ms
Total Talk Time (CUSTOMER): 118424 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/7943b1fd-f931-489e-ba34-1639fe950f56_20250221T14:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, Miss. [PII], my name is [PII], and I was calling from Hill Enhance Family Practice, and we have a patient in that his mom, he's, it's got his mom gave me the information. He don't have his card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it's got American uh public life and it's got a policy number and a medical ID number and a group number that's the only thing she had. I need to verify his insurance to see where I need to send this because I don't have anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and you're needing to verify eligibility and benefit information and get a claims mailing address, is that correct?
[CUSTOMER][NEUTRAL] [PII], mhm.
[AGENT][NEUTRAL] OK, yes, I can help you with those things, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Thank you. And that policy number that you have?
[CUSTOMER][NEUTRAL] That's 02571317.
[AGENT][NEUTRAL] 71317. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits are not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], his date of birth, yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm sorry, what was the date of birth again?
[CUSTOMER][NEUTRAL] [PII] God [PII]. I'm sorry.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] This week [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this limited benefit plan, [PII], and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, this is not major medical insurance. This is a hustle indemnity limited benefit plan.
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK, for an office visit.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] I'm so sorry. Did you say yes?
[CUSTOMER][NEUTRAL] Yes ma'am, uh huh.
[AGENT][NEUTRAL] OK, all right. One moment, please.
[AGENT][NEUTRAL] OK, so on this policy, this limited benefit plans, just one moment, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] System then pull it all up for me.
[AGENT][NEUTRAL] OK, so he has an outpatient sickness rider and for a maximum benefit per visit of $75 and a max number of visits per calendar year of 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you needing, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, that's it. I, I'm just, what do you have, do you have a payer ID?
[AGENT][NEUTRAL] OK, for this policy, the payer ID is 64556.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 645-52. OK.
[AGENT][NEUTRAL] And the claims are mailed to IMA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I think that might be it. I don't, I don't have, I think that might.
[AGENT][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] OK, well, if that's, um, one last thing, [PII], we do have a portal here at APL that once this claim has been processed, you should be able to check claim status and and have access to our explanation of benefits and the website for the portal is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, I think, yeah, that's the side I'm on, but I, it won't let me pull up when I put in my um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 359-548. I put in my.
[AGENT][NEUTRAL] If we did not have a claim on file, right, if we don't have a claim on file yet for him, it's not gonna find it because it's tied to the patient account number that you all have for the member and the tax ID.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if they
[CUSTOMER][NEUTRAL] OK, so when I, his mom gave me a policy number and a medical ID, so I use that.
[AGENT][NEUTRAL] The policy number is what you need to use.
[AGENT][NEUTRAL] But not when you're setting up the portal. When it asks for the patient account number the I believe it states providers patient account number that's referring to the account number you all have for the member that you will submit on the claim like in box.
[CUSTOMER][NEUTRAL] OK then, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Uh, is it 23, 26, 23?
[CUSTOMER][NEUTRAL] OK, I will, I have to look at it. Ours is electronic. I don't really have to look at a claim form but it's fine.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I got you OK and if you for any reason are not able to access it in the portal, you know, you can obviously also call us back for that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK alright well I appreciate it.
[AGENT][POSITIVE] OK, well, if that's all then that I can help you with, [PII], thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Uh, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye