AccountId: 011433970860
ContactId: bbf12ecc-33f6-4052-9736-725e649b0c21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414549 ms
Total Talk Time (AGENT): 140048 ms
Total Talk Time (CUSTOMER): 202243 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/bbf12ecc-33f6-4052-9736-725e649b0c21_20250411T17:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], this is [PII]. Um, I'm with Trustcare and we're an urgent care center in [PII], and I was presented with the, uh, insurance card where I got this phone number from, and I'm trying to determine eligibility, um, but it just says the plan is group hospital indemnity. It doesn't mention anything about medical, you know, like urgent care or doctor's visits.
[AGENT][NEUTRAL] OK. May I have the policy number?
[CUSTOMER][NEUTRAL] Yes ma'am. It's 02599408.
[AGENT][NEUTRAL] And may I have a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, it's, I'm gonna probably say it wrong. [PII]. Date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy you're calling in for eligibility. I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, great. So it's not just the hospital.
[AGENT][NEUTRAL] It's an indemnity policy, which is a limited benefit, and it does show that the member is active with the effective date of [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is there a copay or that kind of stuff, and or, or is there a percentage or co-insurance?
[AGENT][NEUTRAL] Let me pull that up, so you're needing outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, but uh for um urgent care clinic or uh PCP, not for hospital.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] OK, thank you darling.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. For urgent care, the member does have up to $75 per day with a maximum of 6 days per calendar year. So that $75 is the maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that for hospital or urgent care?
[AGENT][NEUTRAL] It's for the urgent care.
[CUSTOMER][NEUTRAL] OK, so their copay would be $75?
[AGENT][NEUTRAL] No, that 75 is the maximum amount that we will pay towards the claim.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Um, is there a specific copay associated?
[AGENT][NEUTRAL] No, this is an indemnity policy. Now you may be able to go in and see if it's under with the multi-plan network and go from there, but that is just the maximum amount that we would pay out.
[CUSTOMER][NEUTRAL] OK, um, OK, I'm don't, I'm trying to figure out what they need to be, you know, charged for the co-pays is my only hold back with that.
[AGENT][NEUTRAL] Yes, if you're listed up under the multi plan you will go in to see and then you would be able to know if there's a discount or anything that is applied for this member.
[CUSTOMER][NEUTRAL] Um, is there any, uh, uh-huh.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK, I don't have access to that. Is that something that you can check for me or transfer me to someone that can?
[AGENT][NEUTRAL] It's a website that you will go up under which is [PII].
[CUSTOMER][NEUTRAL] And you don't have to res uh register or anything?
[AGENT][NEUTRAL] You shouldn't have to.
[CUSTOMER][NEUTRAL] OK, but it's not something you can just.
[CUSTOMER][NEUTRAL] Um, till, OK.
[AGENT][NEUTRAL] We don't have the option to do that. It's based off of the provider is in work with multi plan. If the provider is in network with multi plan, then you would know the discount, the lab or anything for that member.
[CUSTOMER][NEUTRAL] OK, um, OK, so multiplan is now clearer TV or something like that?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] That's what it's saying.
[CUSTOMER][NEUTRAL] So is this uh is this like a um a Medicare or Medicaid network? because that's what it's bringing up. And yeah, you do have to register for it.
[CUSTOMER][NEUTRAL] Um, but it says like I'm a provider for.
[AGENT][NEUTRAL] It does look like they are they have changed over.
[CUSTOMER][NEUTRAL] OK, and where it's saying that I am a provider participates in Medicare and Medicaid networks, is that all that the multi like is this a marketplace insurance?
[AGENT][NEUTRAL] No, this is not a marketplace. This is an indemnity policy which is a limited benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And normally with multiplan, it wasn't based off of Medicare or Medicaid.
[CUSTOMER][NEUTRAL] Yeah, it's just saying a lot about um Medicare and Medicaid on this uh that I pulled up.
[CUSTOMER][NEUTRAL] Um, that's why I'm, I'm trying. Is there someone that I can call? Do they have a number there where they could help me?
[AGENT][NEUTRAL] For multi plan?
[CUSTOMER][NEUTRAL] Uh, or clarity view, um, like, do I need to contact them for the co-pay? Oh, it's not you can't call them.
[CUSTOMER][POSITIVE] OK all right well thank you so much.
[AGENT][NEUTRAL] OK, no problem. Is that you can probably look on the card. Do you see any, let me see if I can see the image of the card.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It it's, it doesn't say anything so this is through his work.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm pulling that up for you.
[CUSTOMER][NEUTRAL] Yeah, it, it literally doesn't say.
[CUSTOMER][NEUTRAL] And the number that they say to get um.
[CUSTOMER][NEUTRAL] You know, the normal, it doesn't guarantee coverage that for eligibility or claim and you know you call this number.
[CUSTOMER][NEUTRAL] I'm just trying to um you know I can't have everything or I can't go forward without knowing if there is um some type of co-pay owed before, you know what I mean?
[AGENT][NEUTRAL] Because normally when we pay up to the $75 if there's not a discount that is allotted then if there's an amount that is left over that is considered patients responsibility.
[CUSTOMER][NEUTRAL] So you'll pay 75 and then whatever else uh they get billed for is their responsibility is what you're what you basically what you're saying? OK, OK dokey alright sweetie well thank you so much.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes ma'am you too bye bye.
[AGENT][NEUTRAL] Bye.