AccountId: 011433970860
ContactId: a1752d4f-fecd-4879-b8cf-65cb8bfc8c33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471970 ms
Total Talk Time (AGENT): 210600 ms
Total Talk Time (CUSTOMER): 236769 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/a1752d4f-fecd-4879-b8cf-65cb8bfc8c33_20250523T16:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] with the Women's Healthcare Associates. I have a new patient coming in on the [PII], and she has added 2 IMA insurances on her insurance screen, and I'm a little confused. I'm hoping that you can help me.
[AGENT][NEUTRAL] OK. Do you have a policy number?
[CUSTOMER][NEUTRAL] I do. I have two. the first one I have is D as in Delta 43300476.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the other one I have is 1547433.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Do either one of those ring a bell?
[AGENT][NEUTRAL] Yeah, I'll have to pull both of those up. Give me a good callback number in case we're disconnected, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you did say you're calling from a provider's office?
[CUSTOMER][NEUTRAL] Yes, Women's Healthcare Associates.
[AGENT][NEUTRAL] So are you needing to verify benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK for what type of service?
[CUSTOMER][NEUTRAL] Woman, uh, she's coming in for uh a woman's health.
[CUSTOMER][NEUTRAL] And, uh, I'm not sure exactly. Yeah, irregular, heavy mins, yeah.
[AGENT][NEGATIVE] I got illness.
[AGENT][NEUTRAL] Is it like a wellness? OK.
[AGENT][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] So it'll be filled with a wellness code versus um um.
[AGENT][NEUTRAL] A diagnosis code.
[CUSTOMER][NEUTRAL] No, if we build with a specialty code, specialty code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what code is that?
[CUSTOMER][NEUTRAL] Uh, oh, hold on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I have to ask my coder. N 92.6.
[AGENT][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Possibly it might morph into something else.
[AGENT][NEUTRAL] Mhm, let's see.
[AGENT][NEUTRAL] OK, so this is a medical concern and it's not wellness. The reason I'm asking, uh, the policy number 1547433, um, there is a wellness benefit under this policy plus an office visit if it's as a result of a sickness, and it is at this time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the the number that you provided, that's with 90 degrees slash IMA they may also offer a wellness benefit if it's for wellness services, that's why I was asking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, that's good to know. OK, so the 1547433, is that um billed to IMA?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it is a medical plan.
[CUSTOMER][NEUTRAL] OK. And is that a PO box? It is a medical plan. OK. And is it [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And what network do you guys use?
[AGENT][NEUTRAL] Um, this is with the multi-plan network of contracted providers. Mhm.
[CUSTOMER][NEUTRAL] Multi-plan.
[CUSTOMER][NEUTRAL] OK, that's what I wanted to make sure that we were in network for her. Do you have a group number she put in a?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the group number, it's usually on that card. I'm showing 70052.
[CUSTOMER][NEGATIVE] Yeah, she didn't provide a card that's why I'm struggling. She did put American Public Lights as a group name, is that correct?
[AGENT][NEUTRAL] Oh, OK. OK, got it.
[AGENT][NEUTRAL] That's the name of the insurance company, which is who you're speaking with.
[CUSTOMER][NEUTRAL] OK, OK, so that's the insurance company. So should it be a different group name?
[AGENT][NEUTRAL] The group which is the employer, the name is Oxford Global Resources is her employer.
[CUSTOMER][NEUTRAL] Global resources. OK.
[AGENT][NEUTRAL] Also with the group mhm and that's 70052 is Oxford's group number or mhm.
[CUSTOMER][NEUTRAL] OK, that's sorry.
[CUSTOMER][NEUTRAL] OK. Sorry, we struggle because we allow them to fill it out now, so.
[AGENT][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] The information we get is kinda disjointed. OK. All right. And what's the effective date she put [PII]?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Uh, let's see, I'll get that for you.
[AGENT][NEUTRAL] OK, so under the policy number 1547433, I'm showing an effective date of [PII].
[AGENT][NEUTRAL] This policy is no longer active as of [PII].
[AGENT][NEUTRAL] So I don't know it's like a temp service if she left the company and then came back and re-enrolled.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Went to 90 degrees, OK.
[AGENT][NEUTRAL] Yeah, it was her policy is with American Public Life.
[CUSTOMER][NEUTRAL] See if she.
[CUSTOMER][NEUTRAL] OK. It is with the Perin. OK.
[AGENT][NEUTRAL] Mhm. But this policy, the number that you gave me is not active.
[CUSTOMER][NEUTRAL] OK. Does she have a different policy?
[AGENT][NEUTRAL] Not with American public life. So what I can do is give you the phone number to 90 Degrees.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have that.
[AGENT][NEUTRAL] And, OK, OK. And you would provide the D number when you call them?
[CUSTOMER][NEUTRAL] Yeah, we deal with a lot of 90 degrees patients.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. I can do that.
[CUSTOMER][NEGATIVE] Why did I, this is, I need eligibility.
[AGENT][NEUTRAL] What is the patient's first name?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] [PII], last name [PII].
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's what I have. All right. I forgot, I didn't verify that, so I wanted to make sure.
[CUSTOMER][NEUTRAL] Yeah. And it says that she's not valid on 90 degrees. OK. So I'm gonna have to actually give them a call.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And so another question you may ask her looks like she presented you with an old card if if she is back with Oxford, if she's been rehired and maybe she's a new enrollee and we've not got the received the information yet. I don't know that's just that maybe a question you may wanna ask her just to be sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. I will do that. OK, so this one doesn't show active and this one doesn't show active. All right. I will get that going and I will give her a holler. Thank you so much. Do you give out reference numbers oh, go ahead.
[AGENT][POSITIVE] You're welcome and I would reach.
[AGENT][NEUTRAL] I was gonna say I would reach out to 90 Degrees to just make sure, um, she may or may not have an active policy with them and you can verify if there's a wellness benefit and a medical benefit under the D number policy.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][POSITIVE] Yes, I was definitely gonna do that.
[AGENT][NEUTRAL] OK, and you'll use my name and today's date as reference for today's call. It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then first initial of last.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh. It's [PII].
[CUSTOMER][POSITIVE] [PII] and [PII], thank you so much. You have the most wonderful day and a wonderful weekend.
[AGENT][POSITIVE] I'm gonna enjoy the 3 days. You're welcome. And thank you, [PII]. You do the same.
[CUSTOMER][NEUTRAL] That's what I figured.
[CUSTOMER][POSITIVE] All right, will do. Thank you. Bye-bye.
[AGENT][POSITIVE] Uh-huh. Bye-bye. Have a good day.