AccountId: 011433970860
ContactId: a5a378ca-cbe5-4928-992a-34723bdc081a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671760 ms
Total Talk Time (AGENT): 282929 ms
Total Talk Time (CUSTOMER): 243515 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/a5a378ca-cbe5-4928-992a-34723bdc081a_20250522T14:52_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] Hi [PII], my name is [PII], and I'm calling from the Will County Community Health Center. I was just on the phone with INA trying to verify a patient's benefits, but they were unable to find the patient in their system because I did not have the, uh, an ID number that started with the letter D.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're wanting to see if the member has coverage with APL?
[CUSTOMER][NEUTRAL] Well, I did, and I did. I've done all of that. The patient does have coverage, um, cause I know that the patient has $75 per day, 6 days per calendar year. It is limited benefits and it is an indemnity policy, but I was instructed to contact INA for further benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now I'm with APL so.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Yes, ma'am. So I cannot access any benefit information related to their coverage. Mhm.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Correct, and that's, that's part of the problem. The problem is you guys are instructing me to go there. They can't find the patient over there, so I don't know what else to do.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] So they may not have benefits with them.
[AGENT][NEUTRAL] You have the, the D number? Do you have the D number that they, that is an IMApo? Yes, see, and we can't access that information.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] No, I don't.
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] We would only be able to give you any information related um [PII] to their APL coverage.
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] Not to IMA. Some of the members have dual coverage with both companies and some have one or the other.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you want to provide, what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, now, I would be happy to try and connect you back to IMA, but if they're telling you that the member doesn't have, you know, they can't locate them, then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] They may, that just may be that they don't have a policy with IMA because their ID card would have that information on there.
[CUSTOMER][NEGATIVE] Yeah, they couldn't locate them.
[CUSTOMER][NEUTRAL] And it doesn't. It just has you guys on there.
[AGENT][NEUTRAL] OK. So that would mean then that they probably do not have a policy with them. I mean, I can't say for certain again since I can't access their information, but if you've spoken to them and they can't locate a policy, like I said, some of the members have
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] They don't have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Dual coverage and some have one or the other.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK 14.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Coverage.
[AGENT][NEUTRAL] But you've already gotten benefits for the member from APL. Is that correct? OK.
[CUSTOMER][NEUTRAL] OK, so they either have the
[CUSTOMER][NEUTRAL] I've only got, I've already gotten benefits from on your side from APL, so I've already done that part, but and like I said, the, the, the first person that I spoke to, she said that I had to go to INA for further.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Medical benefits and then when I
[AGENT][NEUTRAL] OK, what is
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] OK, so it's [PII] [PII] [PII] OK, so what is the
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think it's [PII].
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry, it's in it. OK, sorry, wrong.
[AGENT][NEUTRAL] Mhm. And what is the member's policy number, [PII], with the APL?
[CUSTOMER][NEUTRAL] It is 02560704.
[AGENT][NEUTRAL] OK, thank you. So give me just a moment to pull that member's information up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then any information sent there that I provide would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, [PII], who did you speak to at APL? you said that was today.
[CUSTOMER][NEUTRAL] But yeah, I spoke to [PII].
[AGENT][NEUTRAL] Give me just, just bear with me.
[CUSTOMER][NEUTRAL] No, no, no, you're fine, you're fine.
[AGENT][NEUTRAL] OK, so I mean I see that yes ma'am, she has coverage with APL. She's the spouse of the subscriber.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you said [PII]'s already given you the benefit information on this policy. So again, I will be happy to try and connect you back to IMA, but yeah, if they've already told you they can't.
[CUSTOMER][NEUTRAL] Uh, but if, if I don't, yeah, but if I don't have it they.
[CUSTOMER][NEUTRAL] Yeah, but if they, if they can't find me, if they not find me, if they can't find her in their system.
[AGENT][NEUTRAL] Her
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What do I do?
[AGENT][NEUTRAL] Well, I'm assuming that she does not have coverage with them. She only has APL coverage.
[CUSTOMER][NEUTRAL] Oh, OK, that's OK, but, oh, OK, alright.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] But you, you just stated that she did have.
[AGENT][NEUTRAL] She has coverage with APL, which [PII] gave you benefit information for, but again, IMA and APL are two separate companies.
[CUSTOMER][NEUTRAL] Coverage.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right, right, right.
[CUSTOMER][NEUTRAL] Yes, yes, that, yeah, I got that. OK, but yeah, I mean if they, and I think [PII], she, we, we, I think we did the gambit of trying to find her based on social security number, name, date of birth for her, her husband.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she could not find her.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I, I don't, I have to then we have to reach out to the patient then and find out if they.
[CUSTOMER][NEUTRAL] If they have dual coverage you said, or is it one or the other?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, they could have both, or they could have just APL or they could have just IMA because it's not major medical coverage.
[CUSTOMER][NEUTRAL] And and
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh, it's not
[AGENT][NEUTRAL] No, neither. Correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's not.
[AGENT][NEUTRAL] It is not major medical insurance. This is a limited benefit plan.
[CUSTOMER][NEUTRAL] Being medical.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Medical coverage.
[AGENT][NEUTRAL] It's a hospital indemnity limited benefits plan.
[CUSTOMER][NEUTRAL] So they
[CUSTOMER][NEUTRAL] Right, right, that's what I figured, yeah, when I, when I looked at the card and then when she told me the benefits, um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, your name again was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII], thank you so much for your help.
[AGENT][NEUTRAL] And then you're, you're welcome, [PII], and then if you will end up filing a claim for this member with us, once the claim has been processed, [PII], we do have a portal that you should be able to check her claim status in.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] Yeah, that's not going live until the [PII].
[AGENT][NEUTRAL] Say that again.
[CUSTOMER][NEUTRAL] I tried that already.
[AGENT][NEUTRAL] Well, they're making some changes, yes, they might, but you wouldn't be able to access anything at this point because there's not a claim on file.
[CUSTOMER][NEUTRAL] I said,
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, because even for me to check the bill, yeah.
[AGENT][NEUTRAL] But yes, there are some changes coming, but that will be the, you can't check benefits on there. That's what I'm saying. You can't check benefits even through the portal. That's claim status. Mhm. Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, oh, OK, OK, OK, but in the, uh, but I would be able to do all of that after, I mean, I'm, I'm the, I mean I can bill it out, but, uh, oh my God, patience, but after the [PII] I should be able to, um, go to that secure um website and then be able to look at the claim.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yes, ma'am. You should be, now, on some of these types of policies, sometimes you're not able to pull it up. So if you can't, just call us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because of how the claims are processed, but it, but you should be able to, but if you can't just give us a call.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, OK, well thank you so much, [PII]. You've been extremely helpful.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh, well, it was my pleasure in speaking to you today, [PII]. So, is there anything else that I could help you with?
[CUSTOMER][POSITIVE] Nope, that is it. You have yourself a great weekend.
[AGENT][POSITIVE] Well, I hope you have yourself a wonderful weekend as well and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Alright, bye bye.
[AGENT][NEUTRAL] All right, bye bye.