AccountId: 011433970860
ContactId: 9baad5fa-bd26-40b3-becb-54198aa40ff9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403480 ms
Total Talk Time (AGENT): 162915 ms
Total Talk Time (CUSTOMER): 224205 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/9baad5fa-bd26-40b3-becb-54198aa40ff9_20250102T15:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. I am calling from Alliance Medical Associates. I'm trying to just verify eligibility and also trying to figure out exactly where I would need to go for a prior authorization for the patient for this insurance.
[AGENT][POSITIVE] OK, [PII], I'm happy to help with the eligibility. What is the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want the policy slash certificate number, OK, 02.
[AGENT][NEUTRAL] Yeah, if you have that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah I do it's 02.
[CUSTOMER][NEUTRAL] 57.
[CUSTOMER][NEUTRAL] 636-3.
[AGENT][POSITIVE] Alright, thank you for that, [PII], let me just pull that up here one moment.
[CUSTOMER][NEUTRAL] OK, so quick question for you while you're doing that, so when I put in her medical, uh, when I do her subscriber number, should I put the policy certificate number or the medical ID number?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that number you that you just gave me the 0257, that's the valid number, yeah, it looks like.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, alright, OK, I'm gonna go in and fix my stuff then.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, what is the patient's name?
[CUSTOMER][NEUTRAL] I I never know.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][POSITIVE] OK, yeah, that's right then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And do you have her date of birth?
[CUSTOMER][NEUTRAL] I do, yes, ma'am. It's [PII].
[AGENT][POSITIVE] Alright, thank you so much. So the member's plan is active. The effective date on this is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, this is a limited benefit medical plan meaning that it's gonna pay a set amount depending upon what the patient's being seen for. No pre-authorization is, is needed with this plan, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so no, so no matter what, it's just no off.
[AGENT][NEUTRAL] Yeah, no authorizations needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, so another question for you, uh, because I've never seen this insurance before, so this is something new for me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] As far as like do you guys have like a provider portal website because I do see on here like check claim status or UEOV it looks like there's a secured [PII]. So when I tried to log on that it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I do new user and it comes up and I click that I'm a medical or dental provider but it's asking for like the tax ID is the next screen um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then it's asking me for the patient's account number, um, but then it like it won't do anything else.
[CUSTOMER][NEUTRAL] It tells me that there's no user, you know, was found, um, but I mean I'm not trying to do anything under her account I'm just trying to register for, you know, a portal a provider portal.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So this particular plan, this member's plan actually, um, it looks like the come when you're gonna check claims and send claims they actually go to benefits in a card and so that's why it's probably not letting you set up a portal for this particular member plan because the claims actually go to IMA.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[AGENT][NEUTRAL] And it's a different payer ID than ours, so it's through benefits in a card is who the claims are verified through. I don't know if they have a portal or not.
[CUSTOMER][NEUTRAL] I got you, yeah, because I was trying to do it through I guess whatever it says on the top of this card so when I do put in the address and everything I do do the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The one that it's got on here, the [PII] to [PII].
[AGENT][NEUTRAL] Right, and then the payer ID is, no, that's right, and then it's the payer ID the 64556.
[CUSTOMER][NEUTRAL] Or is there, OK.
[CUSTOMER][NEUTRAL] The 6
[CUSTOMER][POSITIVE] OK, alright, I just wanted to double make double check. I like to make sure I'm good in that area.
[CUSTOMER][NEUTRAL] Because I know how some of these insurances are and it's just like, OK, let me double check because it's definitely a new one that I had never seen before, so you're not sure if the benefits have an actual portal.
[AGENT][NEUTRAL] I, yeah.
[AGENT][NEUTRAL] I don't think they do well because see these are through benefits on a card any time the employer is like a um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] At a staffing agency, yeah, they go through this third party, so let me see what other information I have on them.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And you're looking for medical, right? Not dental.
[CUSTOMER][NEUTRAL] Yes ma'am, right, correct. Let me see, it looks like there's a client order, yeah, because see I typed in benefits in a card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But if it's in a car, it has 3 plans. Mhm.
[AGENT][NEUTRAL] Yeah, all I have is a phone number uh to check claims and it just says option one or it says.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, multi plan doesn't give you anything unfortunately I've already tried contacting multi plan.
[AGENT][NEUTRAL] Yeah, I think that's.
[AGENT][NEUTRAL] Yeah, I think that's just for like uh the patient like to locate providers and stuff, honestly.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, yeah, and it doesn't yeah it doesn't, it doesn't give me any information. I definitely I tried to call and look online, um, yeah, and it won't pull anything up so no worries. I just didn't know if there was because if one has one, I definitely like to have it, you know what I'm saying, um, that way if I have any problems I can go in and look without having to actually call somebody.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Yeah, no, I totally get it, totally get it.
[CUSTOMER][NEUTRAL] Alright, alright, OK, well then I guess that is all I need to know all is required for the patient's policy.
[AGENT][POSITIVE] OK, sounds good [PII]. Well, if you have any other questions or concerns feel free to call us.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes, ma'am, I sure will. Thank you so much. I hope you have a good day.
[AGENT][POSITIVE] You too. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you alright bye bye.
[AGENT][NEUTRAL] Bye bye.