AccountId: 011433970860
ContactId: 8af414af-408d-4e9d-9701-ca8910291576
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338829 ms
Total Talk Time (AGENT): 171918 ms
Total Talk Time (CUSTOMER): 159175 ms
Interruptions: 8
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/8af414af-408d-4e9d-9701-ca8910291576_20250604T13:38_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII] and I'm calling from Elliott Hospital. I'm just trying to verify if this is a medical or just a dental plan for a patient who provided this card.
[AGENT][NEUTRAL] OK, sure, I can assist you with type of plans, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] So it is 02612540.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. All right, so the policy number you just provided to me is dental. Let me check and see if she has a medical card. One moment.
[CUSTOMER][NEUTRAL] Yeah, because on the card it says dental, but I just wanna make sure it's not both med you know medical or dental.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. No, she should have a separate card, but I can go ahead and give you the policy number for the medical. I do see one. let me go ahead and
[CUSTOMER][NEUTRAL] She should have a
[CUSTOMER][NEUTRAL] Is it for, uh, is it through yourselves or is it through a different insurance carrier?
[AGENT][NEUTRAL] It's through us.
[CUSTOMER][NEUTRAL] For the medical? Oh, OK.
[CUSTOMER][NEUTRAL] Alright, well, and what's that then?
[AGENT][NEUTRAL] OK, the policy number for the medical is 02.
[AGENT][NEUTRAL] 61
[AGENT][NEUTRAL] 253 7.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the group number still the same? 752?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and is this coming through a group I would assume, is it, um.
[AGENT][NEUTRAL] Yes, it is a group, uh let me see what's the name.
[CUSTOMER][NEUTRAL] Employer, OK, Carrington.
[AGENT][NEUTRAL] Uh, no, um, no, the group name is Oxford Global Resources.
[CUSTOMER][NEUTRAL] It looks like Carrington I think.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh Oxer globe, OK, that's.
[CUSTOMER][NEUTRAL] Um, let's see here.
[CUSTOMER][NEUTRAL] Does this plan use any particular network?
[AGENT][NEUTRAL] No, um, if the provider participates for multi-plan, they get that additional discount, but it is not required. We don't have a network. OK, OK, perfect.
[CUSTOMER][NEGATIVE] No network.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, we do, OK.
[CUSTOMER][NEUTRAL] Yeah, we're networked with them, OK, or contracted I should say. Alright, what about, um, what would be a claim address to have on file?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for this one, let's see where it goes to. OK, so this one goes to IMA before it comes to to us because they do the repricing. So it goes to IMA and the address is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Egan
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 55121, yes, mhm. And I also have a payer ID if you need it.
[CUSTOMER][NEUTRAL] 55121
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] 645-556.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 645-556.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, oh, and what was the effective date?
[AGENT][NEUTRAL] Uh, let me get that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Let me get to current, OK.
[CUSTOMER][NEUTRAL] Let me just look at something here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Now if they have other insurance, well, it looks like the other product they have is from the exchange so you guys would be primary because you're coming through through group anyways, right?
[AGENT][NEUTRAL] Um, we're not sure if he has any other policies out there, um, but this is just a limited hospital indemnity plan. It is medical, but it's limited. It's a limited plan.
[CUSTOMER][NEUTRAL] If they're getting exchanged.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Would you always be secondary, do you know or like with this type of policy?
[AGENT][NEUTRAL] They can use it as a secondary, they can use it as a primary. It really depends if they have a major medical or not, but that's not something that we really know about the patient or the member, um, so.
[CUSTOMER][NEUTRAL] they can
[AGENT][NEUTRAL] You don't know how they're gonna use it, but this is just a limited policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just wondering because the other ones uh for the exchange, you know, it's not like a group insurance, it's an individual policy as well, you know what I mean, it's, uh, what do you call it like the Obamacare, like the exchanges, you know, where they can get it based on sliding scale and stuff like that, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, so that, that's probably the one that they want to use as a primary probably and then this one is a secondary, but yeah, we don't do coordination, so it's just this one is just gonna pay flat amounts mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, because he
[CUSTOMER][NEUTRAL] OK, yeah, plus your indemnity, so I would assume.
[AGENT][POSITIVE] Yes, and indemnity right.
[CUSTOMER][NEUTRAL] It's just because the exchanges with other group insurance is always secondary typically um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, that's fine um can I hav[PII] a call reference number please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information? All right. My name is So. OK. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh yes please.
[CUSTOMER][NEUTRAL] That's so.
[CUSTOMER][POSITIVE] OK perfect and you're with I'm sorry?
[AGENT][NEUTRAL] APL.
[CUSTOMER][POSITIVE] Oh, which, uh, oh, APL right now, OK, alright, OK, perfect. Alright, so that's all I needed then. Thank you very much.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome, Mr. [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Uh huh have a you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.