AccountId: 011433970860
ContactId: d168b3a5-3134-410f-8992-81afb00bf8e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290480 ms
Total Talk Time (AGENT): 134795 ms
Total Talk Time (CUSTOMER): 95828 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d168b3a5-3134-410f-8992-81afb00bf8e8_20250122T16:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling A of [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling from an outpatient dialysis facility trying to verify benefits on a patient.
[AGENT][POSITIVE] OK, [PII], I can help you with that. Can I get a call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The member's policy number?
[CUSTOMER][NEUTRAL] The number they have listed is 02421864.
[AGENT][NEUTRAL] Remember's name and date of birth?
[CUSTOMER][NEUTRAL] His name is
[CUSTOMER][NEUTRAL] [PII], his date of birth is [PII].
[AGENT][NEUTRAL] OK, [PII], thank you for that. You said you want to verify benefit?
[CUSTOMER][NEUTRAL] Yes, ma'am, for outpatient dialysis.
[AGENT][NEUTRAL] OK, give me 1 2nd please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm showing member's policy active as [PII]. Any benefits are an estimate of coverage. This member is enrolled in a limited policy, so it doesn't cover for um dialysis.
[CUSTOMER][NEUTRAL] Does it, what is it, is it like a hospital indemnity with like $10,000 coverage or something?
[AGENT][NEGATIVE] It's a hospital identity policy, but it's just limited as far as what it covers. Um, it just doesn't have a benefit for the, um.
[AGENT][NEUTRAL] Uh, dialysis, give me one second, let me look at something else.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can you tell me who it's through because the hospital had it listed as a generic multi-plan, so I was trying to, I'm waiting on a card, but I'm trying to see if we could even accept him for our dialysis clinics.
[AGENT][NEUTRAL] Well, it, it is a multi-plan meaning they have a 6 out of the policy and a preventative side. So that's why it's called a multiple, but it's not, there's not a multi-plan discount.
[CUSTOMER][NEUTRAL] OK, so can you give me the, the billing information? Is it, is it correct that [PII]?
[AGENT][NEUTRAL] So that address, it goes to [PII] first because they handle for preventative. Um, once the preventative side processes the claim, um, then they're supposed to forward it over to us. So that's why, um, there's gonna be two different addresses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can you tell me a little bit like what, what are, who are y'all like what uh it said ATL when I called, but I'm trying to figure out the name of the actual company.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So we're um
[AGENT][NEUTRAL] 21. So the [PII] address, that is um IMA and we are uh APL, so like I said there's two companies involved, so that's why it's a multi-plan. So like I said, the [PII] address is for IMA which they do the preventative side of the uh claims and then like I said, when the claims come to us, which is APO we handle for the sick benefits, um, it just like sit on the policy that he has.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, dialysis is not something that's covered.
[CUSTOMER][NEUTRAL] OK, all right, yeah, and just in case he, you know, because sometimes these patients will get like a, they'll qualify for emergency Medicaid or something like that in our state. So, um I'm just trying to verify that because I, if that is the case, I have to send it to you guys to get the denial before Medicaid would consider it. I'm just trying to take everything into consideration. I've heard of like.
[AGENT][NEUTRAL] Yes, ma'am. That's fine. I mean, um, you.
[AGENT][NEUTRAL] You can send it to us as the fine to get that now, but I mean I can give you our direct address, um, but like I said, normally it's sent over to them as well, um, because, uh, like that.
[CUSTOMER][NEUTRAL] To go through them first, OK.
[AGENT][NEUTRAL] Yes, um, but like if you want our address, that's fine. I can provide that to or I can give you our fax number.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Um, yeah, your facts would be great.
[AGENT][NEUTRAL] OK, so our fax number is [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. OK, [PII], that's what I needed to know. Thank you so much.
[AGENT][NEUTRAL] Excuse me.
[AGENT][POSITIVE] No problem, [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all I needed.
[AGENT][POSITIVE] Alright, thanks for calling. You totally have a wonderful day.
[CUSTOMER][NEUTRAL] OK.