AccountId: 011433970860
ContactId: 9212f0d4-565d-4e78-8e35-3a62ead9c55e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694400 ms
Total Talk Time (AGENT): 310364 ms
Total Talk Time (CUSTOMER): 273452 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/9212f0d4-565d-4e78-8e35-3a62ead9c55e_20250115T22:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? I wanted to check um eligibility for a patient that we have.
[AGENT][NEUTRAL] OK yeah I can check eligibility for you. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII], last initial is [PII].
[AGENT][POSITIVE] OK, thank you so can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is uh [PII].
[AGENT][NEUTRAL] OK thank you and then did you have the policy number?
[CUSTOMER][NEUTRAL] You know what? No, because she gave me a card that has 1000 things on there, but I, when I called in on the number they gave me your number because they, I, she said that's for vision and dental. What they gave me was D412-00182.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's gonna be a that's the policy number for um 90 Degrees that's not ours um let's see, do you have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] No, I have their name, phone number, ID. She's a, she registered as a patient.
[AGENT][NEUTRAL] OK, um, let's try the only other thing I could try is the name if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell the last name again? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] I'm sorry, [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, [PII], yes.
[AGENT][NEUTRAL] OK, OK thank you one moment please.
[AGENT][NEUTRAL] Uh, what state, uh, does [PII] live in?
[CUSTOMER][NEUTRAL] Um, let me see what she has.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then did you have the date of birth?
[CUSTOMER][NEUTRAL] Yes, it is gonna be [PII].
[AGENT][NEUTRAL] OK, do you believe I found her. Let's take a look here.
[AGENT][NEUTRAL] Um, so this was for medical correct?
[CUSTOMER][NEUTRAL] Yes, this is gonna be for a doctor visit.
[AGENT][NEUTRAL] OK, alright, so I did find her policy uh let me know when you're ready for that policy number.
[CUSTOMER][NEUTRAL] OK, what is it?
[AGENT][NEUTRAL] It is 02.
[AGENT][NEUTRAL] 30
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4814.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's her ID number?
[AGENT][NEUTRAL] This is her policy number for us, yes.
[CUSTOMER][NEUTRAL] OK, so and then what is the plan under? Like I'm trying to find it. What's the name of the plan?
[AGENT][NEUTRAL] The name of the plan for us, so it is, this is hers through American Public Life. It's called Hospital indemnity. It's a limited indemnity medical plan.
[AGENT][NEUTRAL] But since especially since you gave me that uh 90 degree um member ID this is part of a multi plan.
[CUSTOMER][NEUTRAL] OK, so, uh, OK, so if I'm gonna put it in the system, it's not Blue Cross Blue Shield, so it's called hospital.
[AGENT][NEUTRAL] Hospital indemnity and this is uh their American public life.
[CUSTOMER][NEUTRAL] I don't even have a hospital indemnity. Oh my goodness.
[AGENT][NEUTRAL] Uh, it's just a limited indemnity medical plan is what it's called. I don't know if that would.
[CUSTOMER][NEUTRAL] OK, let me see if that helps limited and.
[AGENT][NEUTRAL] Help
[CUSTOMER][NEUTRAL] OK, let me see Linda entity and then I have 02304814.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] OK, IBA multiplan indemnity?
[AGENT][POSITIVE] That sounds right, yes ma'am.
[CUSTOMER][NEUTRAL] And then the PO box is [PII].
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You know, I think that's 490 degrees. I can give you hours.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Let me know when you're ready for ours. I'll go ahead and give that to you.
[CUSTOMER][NEUTRAL] Yeah, let me get the address so I can try to search it.
[AGENT][NEUTRAL] Right, um, so our claims mailing address is uh [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] sure sorry let me know when you're ready.
[CUSTOMER][NEUTRAL] Hold on one second, I'm sorry.
[CUSTOMER][NEUTRAL] I'm so sorry. No, I'm just saying, OK, [PII]. What is it?
[AGENT][NEUTRAL] No, it's OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that is in [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] OK, give me, yeah, I don't even see that on there. It's not even give me an option like to populate.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so what I'm thinking I might go ahead and give you because you said this was for an office visit, is that correct?
[CUSTOMER][NEUTRAL] Yes, can you tell me if we're in network with this insurance if I give you our um NPI?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I can tell you that this plan does not have a set network again as it's a limited indemnity plan it is a little bit different um it essentially just pays a set dollar amount per coverage or office visit so it does not have a set network also um.
[AGENT][NEUTRAL] I'm trying to see if office visits are even covered under this policy. It is one that's limited is very limited, um, of course, before I go any further, I will let you know verification of coverage is not a guarantee of payment for games, um.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Was this for was it like a wellness exam or was this for um like uh regarding a sickness or an accident?
[CUSTOMER][NEUTRAL] No, this is for like an office visit to get um polymedic medication for diet.
[AGENT][NEUTRAL] OK, so then that one that's not going to be a covered visit so this plan has wellness visit benefit and then a sickness outpatient visit benefit.
[AGENT][NEUTRAL] And that is it, so.
[CUSTOMER][NEUTRAL] OK, so wellness and then it won't cover the medication for um.
[CUSTOMER][NEUTRAL] It won't cover diet medication, right?
[AGENT][NEUTRAL] I don't think so um I can see.
[AGENT][NEUTRAL] I think they're uh prescription benefits are through a different carrier again these multi plans or something if you would like to sell um what I was thinking was I can give you the phone number to 90 Degrees if that's the information that they gave you before and you can speak with them to see if they have any other benefits that we may not have or be aware of.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] No, they just told me that you they they don't handle any of that. They said that you guys handle it.
[AGENT][NEUTRAL] OK, OK, so then it would be limited to this, OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So, um, yeah, so I'm just trying to figure out like a multi plan.
[AGENT][NEUTRAL] Yeah it's it's a bit confusing OK so yes the.
[CUSTOMER][NEGATIVE] Oh, I don't even know how it works.
[AGENT][NEUTRAL] Pharmacy benefits are through Farma Vale.
[AGENT][NEUTRAL] So I'm not I can't see oh sure.
[CUSTOMER][NEUTRAL] Um, let me see, hold on.
[CUSTOMER][NEUTRAL] Um, oh my God, so you said indemnity.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Indemnity. OK, let me see, and then I'm gonna try to put that code in again. Is there a group number or anything like that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see, let me get that group number.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Group number is 70,030.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 70,030.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, let me see this one indemnity. Let me see if it pops up. This is crazy. Hold on.
[CUSTOMER][NEUTRAL] Heartland American Health, it's not American Health, American Network.
[AGENT][NEUTRAL] This one is American Public Life.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I've got here let's see, I don't know if this will help or not uh limited benefit hospital indemnity I think you searched hospital indemnity though.
[CUSTOMER][NEUTRAL] Oh my god.
[CUSTOMER][NEUTRAL] Limited.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Limited hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see. I don't, I don't see, I see basic medical hospital. Let me see. I don't see limited anything, limited hospital. Let me see if something else comes up.
[CUSTOMER][NEUTRAL] This is crazy. OK, um, let me see, is there a phone number?
[AGENT][NEUTRAL] For, um,
[AGENT][NEUTRAL] 90 degrees or for Firmavale?
[CUSTOMER][NEUTRAL] Let me see if I could try to get it with the let me see if I can search by the phone number that I did initially um.
[AGENT][POSITIVE] Oh, for us, I'm sorry.
[CUSTOMER][NEUTRAL] The [PII], I'm gonna try that one. OK, let's see.
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And you said you won't be able to tell us if we are in network, right?
[AGENT][NEGATIVE] Not for this plan, no.
[CUSTOMER][NEUTRAL] OK, let me see if I can just use the repeat 0.
[CUSTOMER][NEUTRAL] See if it works.
[CUSTOMER][NEUTRAL] I end up putting some other name and it's the American Health.
[CUSTOMER][NEUTRAL] Me, oh, this is Medicare. Jesus Christ. I'm just gonna call the patient and say we don't take your insurance.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] Like to be I mean it's just being honest like I don't even know it doesn't cover anything. It covers wellness checks and that's it, right?
[AGENT][NEUTRAL] For this plan it's more about um I think it's got several.
[AGENT][NEUTRAL] Because each of them are so different, but this one is gonna be more.
[CUSTOMER][NEUTRAL] Well, what's her plan? What's her plan?
[AGENT][NEUTRAL] Hospital consignment, yeah, it's that limited benefit hospital indemnity is what the technical name or hospital indemnity, um.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Bear with me just a moment. I just had it up.
[AGENT][NEUTRAL] OK, so, um, hospital confinement benefit intensive care coronary care, uh, wellness diagnostic test, um.
[AGENT][NEUTRAL] Hospital or excuse me um outpatient sickness rider and then there's a surgical and anesthesia benefit.
[CUSTOMER][NEUTRAL] So they don't cover weight loss, um.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Like a weight loss check.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, well, let, yeah, if I can just have a reference number, I'm gonna call this patient so we can't take her insurance.
[AGENT][NEUTRAL] OK, sorry for all the confusion. I know this plan is a bit different.
[AGENT][NEUTRAL] Uh, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII], and then was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then uh you said and then today's date?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, no, that'll be all, and then you said this is called indemnity?
[AGENT][NEUTRAL] Yes, Hospital indemnity is the name uh limited benefit indemnity.
[AGENT][NEUTRAL] Hospital indemnity.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] Alright yeah thank you I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Bye bye.