AccountId: 011433970860
ContactId: f6ba5bdc-a89c-4ac2-9a2f-5a5258aba63f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211880 ms
Total Talk Time (AGENT): 105865 ms
Total Talk Time (CUSTOMER): 83168 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/f6ba5bdc-a89c-4ac2-9a2f-5a5258aba63f_20250620T14:21_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. So my name is [PII], and I'm calling you from SNCL walk-in clinic in [PII].
[CUSTOMER][NEUTRAL] I'm calling because we did see one of your patients, one of your members, um, and I'm calling to see if my provider um participates with this insurance since she is in network with multi plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you help me out with that?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I can check and see um where uh how I can help you with the network information, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02622774.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. [PII], and what is the name of the facility you're calling from whom I know?
[CUSTOMER][NEUTRAL] Essential walk-in primary care clinic.
[AGENT][NEUTRAL] OK, thank you. All right. um, so this particular policy is one of our limited hospital indemnity plans. It is a limited policy and this one, if the provider participates with multi-plan, they get that additional discount, but it is not required. We don't have any network.
[CUSTOMER][NEUTRAL] So if she is in um in network with multi plan she can bill for this for the services?
[AGENT][NEUTRAL] Um, yeah, we,
[AGENT][NEUTRAL] Yeah, we don't have a network, meaning that we pay a flat amount, um, for the benefits, we pay a flat amount. So, um, we'll pay the same amount even if it's in network or out of network because we don't have a network. Now if the provider participates with multiplan, they get an additional discount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, additional discount, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Discount, OK, and do you have a fax to send claims?
[AGENT][NEUTRAL] Yes, we do. Um, well, let me see where this one goes. I do apologize. Let me see because we have two different ones. Bear with me just a second. Let me see if this one comes to us. OK, this one doesn't come to us because it needs to be repriced by multi plan, so it will go to IMA and IMA doesn't have a fax. We have a mailing address and a payer ID.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, OK, and you do they do accept, um, paper claims, right?
[AGENT][NEUTRAL] They do, yes. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, so I'll be sending it by, by, um, mail it's IMA Inc [PII].
[CUSTOMER][NEUTRAL] 05-5121.
[AGENT][POSITIVE] That is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, what's the timely limit to submit a claim?
[AGENT][NEGATIVE] No timely filing limits.
[CUSTOMER][NEUTRAL] No time any finance, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] All right, thank you very much for all your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] That's it for now.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. Have a good day, Miss.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.