AccountId: 011433970860
ContactId: ce29d3ab-9844-46f9-88ec-1e78950349d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639289 ms
Total Talk Time (AGENT): 167410 ms
Total Talk Time (CUSTOMER): 362037 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/ce29d3ab-9844-46f9-88ec-1e78950349d4_20250212T16:04_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. How are you doing this morning?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm good. I was calling because I'm calling from ASC Urgent Care and I need to verify eligibility benefits for a patient that we saw today. When I put in.
[CUSTOMER][NEUTRAL] I'm sorry? Yeah, that kiosk right there.
[CUSTOMER][NEUTRAL] Um, sorry about that. So, um, he was seen today, but when I put his insurance in through there, it just says subscriber not found. I did speak to another gentleman prior to calling you and he did update that member ID number for me and so I tried to verify it again and it's still saying the same thing that subscriber not found so I just wanted to know um how I can try to get these um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Get this verified so that he doesn't get a bill.
[AGENT][NEUTRAL] OK. Um, what is the policy number, [PII]?
[CUSTOMER][NEUTRAL] So the policy number on his thing is, let me see, I don't know because I just have his card.
[CUSTOMER][NEUTRAL] I just have to pick the postcard policy number.
[CUSTOMER][NEUTRAL] I don't see a policy number on here. I don't, I don't have his policy number.
[AGENT][NEUTRAL] What's on the card that you have?
[CUSTOMER][NEUTRAL] I'm just calling to
[CUSTOMER][NEUTRAL] Um, I see, uh, a payer ID. I see a member ID, an employee ID, a group number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A VIN number? I don't, it doesn't say nothing about a policy number.
[AGENT][NEUTRAL] What, what's the member ID?
[CUSTOMER][NEUTRAL] So the member ID that the gentleman gave me when I called prior to you.
[CUSTOMER][NEUTRAL] He said that might be a 0 in front but he's not sure he just gave me 258-4870.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, the phone number here is [PII] and my name is [PII].
[AGENT][POSITIVE] OK, thanks.
[CUSTOMER][POSITIVE] Thank you, and just bear with me for one second because I gotta, I gotta check in this patient real quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold OK?
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Uh, you're welcome. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, the patient's first name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] And then the last name is [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that information, [PII]. So that is the correct policy number for American Public Life.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the eligibility date effective the effective date is [PII]. This policy is active, and you said this is for an urgent care visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, January, you said [PII] was the effective date?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and what did you say after that? I'm sorry.
[AGENT][NEUTRAL] I was verifying the benefit that you needed. Did you say urgent care?
[CUSTOMER][POSITIVE] Yes, uh huh, yes, that's correct.
[AGENT][NEUTRAL] OK, OK, give me one moment.
[CUSTOMER][NEUTRAL] But it is active and he is eligible.
[AGENT][NEUTRAL] He is.
[CUSTOMER][NEUTRAL] OK, and what's your name? I'm sorry.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII] first initial last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for the
[CUSTOMER][NEUTRAL] So I'm not really sure why it's coming up subscriber or not found because I ran it through as American Public Life Insurance. Is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, it's coming up subscriber not found and I have his ID number in there.
[AGENT][NEUTRAL] Put a, put a 0 in front, did you put a 0 in front of the number?
[CUSTOMER][NEUTRAL] And then on the coverage.
[CUSTOMER][NEUTRAL] I did not, but I can try that. I can try that.
[AGENT][NEUTRAL] Try putting a 0 in front of the number.
[CUSTOMER][NEUTRAL] OK, let me try that while you're on the phone.
[CUSTOMER][NEUTRAL] Let's see, let's try that one more time.
[CUSTOMER][NEUTRAL] With a 0.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] No, it's still saying.
[CUSTOMER][NEUTRAL] Subscriber I found.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And tell me what, what, what information are you entering?
[CUSTOMER][NEUTRAL] I'm gonna read to you what it
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] The coverage details says required application data missing. Please correct and resubmit. Payer ID 645556 is not set up for eligibility. Please edit and resubmit. So I don't know if it's something that maybe I'm putting in incorrectly.
[AGENT][NEUTRAL] Is, is it asking for the insurance company name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So when I originally did it.
[CUSTOMER][NEUTRAL] I have all of his information in here correct.
[AGENT][NEUTRAL] Because the payer ID number you said was 64556, um, the claims are to be mailed that's the correct payer ID number, but the name of the entity is IMA and not American Public Life, so maybe it's saying the payer ID number that you entered doesn't match APLs because our payer ID is different. So in IMA and see what happens.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, so
[CUSTOMER][NEUTRAL] OK, let me do, let me do it this way then. What is it IMA?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, ice, Mary Apple.
[CUSTOMER][NEUTRAL] Imy apple. Let's see if that works.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I am a Inc big line of business or Imagine Health.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, is it giving you the, um, give me a second, just wanting to know what that acronym is for.
[AGENT][NEUTRAL] The IMA
[CUSTOMER][NEUTRAL] I, yeah, Inc VIC line of business 64556 so I'm thinking maybe that's the one.
[AGENT][NEUTRAL] It is, it's
[AGENT][NEUTRAL] That's, that's it.
[CUSTOMER][NEUTRAL] OK, let me add that.
[AGENT][NEUTRAL] And it's for insurance management and administrators is what that stands for.
[CUSTOMER][NEUTRAL] OK, good. Can I just put you on a brief hold real quick so I can help this patient. I'll be right back. Please don't hang up.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEGATIVE] I won't, I won't.
[CUSTOMER][NEUTRAL] Hold on. OK.
[CUSTOMER][NEUTRAL] OK, um, 645-56 add.
[CUSTOMER][NEUTRAL] What was that, um.
[CUSTOMER][NEUTRAL] The member ID number again, hold on.
[CUSTOMER][NEUTRAL] Member ID oh darn, I didn't write it down. What is it? 0, what did I say? 0.
[AGENT][NEUTRAL] 0258.
[CUSTOMER][NEUTRAL] 0258.
[AGENT][NEUTRAL] 4870.
[CUSTOMER][NEUTRAL] 4870.
[CUSTOMER][NEUTRAL] And let's put the effective date you said was [PII].
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] [PII] maybe maybe that will make a difference. Let's see.
[CUSTOMER][NEUTRAL] All right, cross your fingers.
[CUSTOMER][NEUTRAL] It says this is a non part participating insurance. Does is he covered for urgent care benefits?
[AGENT][NEUTRAL] Mhm, there is an urgent care benefit um the PPO network of contractor providers is multi-plan.
[CUSTOMER][NEUTRAL] Or maybe we just
[CUSTOMER][NEUTRAL] Does is AFC urgent care one of the ones that he can go to?
[AGENT][NEUTRAL] We do not have a list of their contracted providers um so I cannot verify if it's part or not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] But if you are or are not, um, a benefit can still be provided.
[CUSTOMER][NEUTRAL] OK, well, I'm gonna put that note in there because it's saying it's a nonparticipating insurance which I, I don't know, I don't, I feel like I've seen this before and we have taken it before so I'll let the insurance department figure that out.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On our end
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] And I did my due diligence.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But he is active and he is eligible and effective was [PII]. Is there like a reference number or claim number that I could put on the billing alert to let them know like hey this is.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Anything? No?
[AGENT][NEUTRAL] So as your the reference, you'll use my name in today's date. um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well I'll just document this on his chart, and I already did tell him that if anything came back inactive or ineligible or for some reason we don't take it or there's an issue, then he would get a bill for today's visit and a co-pay if there is one so um.
[AGENT][NEUTRAL] Yeah, which it is covered, it is covered under his policy, so it'd be a matter of just us submitting a claim, mhm APL.
[CUSTOMER][NEUTRAL] Yeah, so it should be all.
[CUSTOMER][POSITIVE] Right yeah OK alright well thank you so much I appreciate you.
[AGENT][NEUTRAL] Oh, you're welcome, [PII]. Anything else?
[CUSTOMER][NEUTRAL] No, that's it for today.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day bye bye.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You too bye bye.