AccountId: 011433970860
ContactId: fa37d0be-6ebe-4b1b-9888-741fc7444dab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368130 ms
Total Talk Time (AGENT): 168278 ms
Total Talk Time (CUSTOMER): 86549 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/fa37d0be-6ebe-4b1b-9888-741fc7444dab_20250110T15:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. Um, I, my name is [PII]. I work at Oak Grove Urgent Care and I have a patient here, um, and I'm not sure if we take this insurance, um, so I was just wondering, I have his name and date of birth and everything whenever you're ready.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], so you're needing to verify eligibility and benefits or find out about? Yes, ma'am, I can help you with that, [PII]. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Let me look at our card. I don't remember our number. OK, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02506723
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And any information that I provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] is [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Just one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this uh limited benefit plan. It is Active [PII] with an effective date of [PII].
[AGENT][NEUTRAL] And give me just a moment.
[AGENT][NEUTRAL] And you said you're with an urgent care, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, Oak Grove Maxim Urgent Care.
[AGENT][NEUTRAL] Now they're um let's.
[AGENT][NEUTRAL] OK, so there is not a network with this plan?
[AGENT][NEUTRAL] Again, this is not major medical insurance. It is a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] And one moment, I'm still checking your benefits for urgent care.
[CUSTOMER][MIXED] You're good, so it probably won't cover.
[AGENT][NEUTRAL] Um, it, it may cover for, give me just a minute.
[AGENT][NEUTRAL] OK, so he does have a benefit on his plan for urgent care. That is a $75 benefit.
[CUSTOMER][NEUTRAL] That's like her pay.
[AGENT][NEUTRAL] No, ma'am, there's not a co-pay. This is not a major medical insurance. This plan just pays specific amounts for certain services, and the benefit amount that this plan would pay for a coverage service for an urgent care is $75.
[CUSTOMER][NEUTRAL] OK, so if, since our clinic, it's 125 for a visit, it wouldn't cover it.
[AGENT][NEUTRAL] The max benefit on this plan would be $75.
[AGENT][NEUTRAL] If
[CUSTOMER][NEUTRAL] And that's all that they would cover.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so I'd have to charge him for the rest of the visit?
[AGENT][NEUTRAL] We do not determine patient responsibility, but since we're not a major medical carrier, that would be up to the
[AGENT][NEUTRAL] Provider.
[CUSTOMER][NEUTRAL] OK, OK, that's fine. I'll call my manager. I'm just making sure.
[AGENT][NEUTRAL] Absolutely, no ma'am, I understand. And should you all end up filing a claim with APL [PII], once the claim has been processed with us, we do have a portal in which claim status can be checked and also a copy of our explanation of benefits may be obtained and our portal website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] Repeat that first at the beginning.
[AGENT][POSITIVE] Secured.
[AGENT][NEUTRAL] Do you need me to
[CUSTOMER][NEUTRAL] A in public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I have it thank you.
[AGENT][POSITIVE] OK. Well, you're certainly very welcome. So is there anything else, [PII], that I can help you with today?
[CUSTOMER][NEUTRAL] That should be all.
[AGENT][POSITIVE] OK. Well then, thank you again for calling APL and I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][NEUTRAL] Bye.