AccountId: 011433970860
ContactId: c1343796-e3df-474e-a680-ba01e3ba4594
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422519 ms
Total Talk Time (AGENT): 151781 ms
Total Talk Time (CUSTOMER): 157598 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c1343796-e3df-474e-a680-ba01e3ba4594_20250206T21:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, yes, my name is [PII], and I'm calling from Pmont Urgent Care. I'm just trying to verify that, uh, a patient is in network with us and um, if she could be seen today at our facility.
[AGENT][NEUTRAL] OK, and you said you're calling from which urgent care center, ma'am?
[CUSTOMER][NEUTRAL] Piedmont urgent care Piedmont.
[AGENT][NEUTRAL] Piedmont Piedmont. OK, thank you. And then, um, Miss [PII], what is your, um, callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII] Last name [PII]
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] Mm, how do I get her policy numbers? Would that be her, this is for medical.
[AGENT][NEUTRAL] OK, it might say inpatient certification number or outpatient certification number or it could even say member.
[AGENT][NEUTRAL] ID number?
[CUSTOMER][NEUTRAL] OK, one
[CUSTOMER][NEUTRAL] Um, let me get her mem I have her, her, oh, I have her policy number. I'm sorry, it's 025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 951.
[CUSTOMER][NEUTRAL] 17.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. Her effective date is [PII].
[CUSTOMER][NEUTRAL] OK, hold on one second. I have to, OK, so it's effective, yes, and you said.
[CUSTOMER][NEUTRAL] With 2.
[AGENT][NEUTRAL] [PII] it'll be is when the effective date is.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] OK, so I first off, can I get the um the phone number that I'm speaking to you on? It's a list, it's a um list of stuff that we have to ask. Can I get the phone number from this number we're speaking on? Do you know it?
[AGENT][NEUTRAL] Uh, it's the number that you called.
[AGENT][NEUTRAL] It's going to be, let me look, let me look it up real quick.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, no, because he transferred me over so I wasn't able to um.
[AGENT][NEUTRAL] Oh OK. Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK, may I get your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And the last, the initial of your the first letter of your last name I'm sorry.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK, and the claims mailing address?
[AGENT][NEUTRAL] Claims email address is [PII].
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, one second. [PII].
[CUSTOMER][NEUTRAL] City [PII] and one more time for the zip code.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, so I got a [PII]. OK, you said her coverage effective date, yes, and her insurance type?
[AGENT][NEUTRAL] It's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mm, OK, so it'll be other because it's not an HMO PPO or POS, right?
[AGENT][NEUTRAL] No, it's not a major medical. It's a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is she able to be seen at urgent care?
[AGENT][NEUTRAL] Let me look um real quick at her policy and see what she has as far as benefits.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] And this is, this is just to cover her um just to verify her coverage and it's not a guarantee of payment. She does have outpatient.
[AGENT][NEUTRAL] Benefit in an urgent care center, she gets 4 visits a year for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she has a $50 benefit amount.
[CUSTOMER][NEUTRAL] So y'all only cover $50 in her visit.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And she has, she'd be responsible for the rest, correct?
[AGENT][NEUTRAL] We don't get patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] OK, I just, OK, that's fine, um, the payer name, it will be American Public Life.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I get the group name please?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Her group name is Serge Staffing.
[CUSTOMER][NEUTRAL] S E R G E
[AGENT][NEUTRAL] S U R G E.
[CUSTOMER][NEUTRAL] S U R G staffing.
[CUSTOMER][NEUTRAL] And may I get her group number?
[AGENT][NEUTRAL] Yes ma'am, it's 70084.
[CUSTOMER][NEUTRAL] OK, 70084. Can I get her subscriber ID please?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It's the policy number that you gave me, the 259-511-17.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And um urgent, does she have an urgent care co-pay that you know of?
[AGENT][NEUTRAL] Let me look at our benefits again and we'll look and see.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] You said she don't?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Does she have an individual deductible?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEGATIVE] No family deductible honestly um.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No urgent care co-insurance.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, OK, um, well I think that's all I needed from you today. I appreciate you so much for assisting me.
[AGENT][POSITIVE] It's not a problem at all, Ms. [PII]. I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mm