AccountId: 011433970860
ContactId: fbc9b074-66c1-4661-92b6-f9dc322edaeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 719549 ms
Total Talk Time (AGENT): 306837 ms
Total Talk Time (CUSTOMER): 326084 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/fbc9b074-66c1-4661-92b6-f9dc322edaeb_20250522T16:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just to verify.
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, can you hear me?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, OK, I can hear you now. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling in to inquire about my out of pocket costs for my urgent care visit.
[AGENT][NEUTRAL] OK, um, I can help you with your coverage. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] 02567164
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify um your date of birth, mailing, and email address on file?
[CUSTOMER][NEUTRAL] Dr
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And the email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, hold on one moment, I'm just waiting for your benefits to populate. So you don't have any like out of pocket. This isn't a major insurance policy, um, but just for the benefit, the policy would pay.
[AGENT][NEUTRAL] Up to $75 per visit with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, so they pay up to $75.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] On each visit for 5. OK, cause I tried to call in to give them my information and I'm just, I guess I'm just really confused and I've talked to a lot of people, so I hope you can just understand my frustration a little bit. Um, what information do I give urgent care to be able to make sure that this is covered?
[AGENT][NEUTRAL] So anytime a provider gives you pushback, just give them your policy number with us and our phone number and just say call my insurance company to verify the benefits and we'll take it from there. Um.
[CUSTOMER][NEUTRAL] Cause they said like uh APL American Public Life, like I tried to give it to them both ways and they were like, that's not something that we have like as an insurance provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] I don't know if they're thinking APL is the name of the product and they're saying we don't take it or they just need to call us so we can go over the benefits.
[AGENT][NEUTRAL] Because a lot of companies will say that they don't, it's APL, they're thinking APL is the insurance. No, that's the insurance company, we have products, but we, so that you don't have to be frustrated and go through all that with them, just give them our phone number and let them call us so we can verify.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] With them.
[CUSTOMER][NEUTRAL] OK, because I have, I am utilizing.
[CUSTOMER][NEUTRAL] A third party for insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Creative circle and the only thing when I called after I gave them the policy number and medical ID number off of this APL card is I said 90 degree benefits because that's where my preventative is and they said, oh yeah, that's what we have. So I'm just, I just wanna make sure that I, and I know what you're saying just give, but she didn't sound like she was like willing to do that because she didn't even have APLs like I guess a selection.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have their phone number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, yeah, I do.
[AGENT][NEUTRAL] OK, well, we can call them.
[CUSTOMER][NEUTRAL] I can't um
[CUSTOMER][NEUTRAL] OK. Um, my appointment is at [PII] central time.
[AGENT][NEUTRAL] OK. Oh, today, OK.
[CUSTOMER][NEUTRAL] So, um, yeah.
[AGENT][POSITIVE] Well, sure, I can definitely call for you.
[CUSTOMER][NEUTRAL] Yeah, so they can't.
[CUSTOMER][NEUTRAL] Um, thank you. Um, they said that they can't run anything until I'm actually there, so.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] is it.
[CUSTOMER][POSITIVE] Easier to just
[AGENT][NEGATIVE] Well, they won't be running anything. I'm just giving them a call to let them know that you do have coverage and to let them know what the coverage is, so they'll start giving you a hard time. They're not gonna run anything until you're there and um at the appointment time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, yeah, um, let me pull up the phone number, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] so their phone number.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, hold on one moment for me, OK, I'm just gonna call on the other line and then connect everybody.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][NEUTRAL] OK, hold on one second. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] She don't even sound like she feel good and they're just gonna give her a hard time.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hi, this is [PII] with equity Urgent Care. How can I help you?
[AGENT][NEUTRAL] Hey, my name is [PII]. I'm calling from American Public Life. We have a mutual patient. Um, she's scheduled for today. I think she said at [PII]. She's on the line as well. Um, she's getting some pushback about her insurance type, so I'm just calling to verify her insurance with her or with you, so when she comes in for an appointment, she won't get a hard time anymore.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Try trying to it's for um.
[CUSTOMER][NEUTRAL] I think the [PII] that we have.
[CUSTOMER][NEUTRAL] Um, can you give me a moment please?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, alright, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I just wanna make sure you're with me.
[CUSTOMER][POSITIVE] Thank you for holding how may I help you?
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from APL. Um, we have a mutual patient that's coming in today for with you at [PII], I believe she said, um, but she's getting some pushback about her insurance. I'm just trying to verify her urgent care coverage with you also so she can be seen without trouble today.
[CUSTOMER][NEUTRAL] OK, do you know what her copay is and her co-insurance or deductible?
[AGENT][NEUTRAL] It's a hospital indemnity policy, none of that applies.
[CUSTOMER][NEUTRAL] OK, so she has no copay, no co-insurance, and no deductible.
[AGENT][NEUTRAL] Right, it's a hospital indemnity policy, so it's a limited medical policy. The policy will pay up to $75 per urgent care visit with a max of $5 per calendar year.
[CUSTOMER][NEUTRAL] Alright, so the insurance will pay up to $75 so her visit would be.
[CUSTOMER][NEUTRAL] If it's 150, y'all cover 75 and she's responsible for the other.
[AGENT][NEUTRAL] Um, we don't determine patient responsibility, but if you have to build, then, I mean,
[AGENT][NEUTRAL] That's how it has to be handled.
[CUSTOMER][NEUTRAL] OK, so then it would be a co-insurance and copay then.
[CUSTOMER][NEUTRAL] Is it the actual insurance that I'm speaking with?
[AGENT][NEUTRAL] You're speaking with the insurance company. There is no co-pay. There's nothing to pay upfront unless you have a self-pay fee.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that is the amount that we will apply to the office visit.
[CUSTOMER][NEUTRAL] OK, so then, yes, so $150 and then your insurance will pay $75. OK, alright, and then as far as co-insurance they will pay the 100% right, not 70 up to $75 for everything or?
[AGENT][NEUTRAL] It's just the 75 flat.
[CUSTOMER][NEUTRAL] So if you can
[CUSTOMER][NEUTRAL] I'm sorry, so if she comes in and she has an office, OK, if she comes in and she sees the doctor, the doctor does treatment, so $75 will go towards everything that y'all would pay, or
[AGENT][NEUTRAL] Yes, that is the max that will be paid towards whatever the total is.
[CUSTOMER][NEUTRAL] OK, so she, right, OK, so she would have to pay for something. OK, and is there a mailing address that they send this up because she says it's 90 degrees, so we do, do, uh, we are, you know, with the insurance with 90 Degrees, is there a billing department, a mailing address we have to send the claims to to make sure we get to the right one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, you can mail it or you can send it electronically. I have the PO box and the payer ID. Uh, would you prefer one over the other or both? I can give you both.
[CUSTOMER][NEUTRAL] PO box.
[AGENT][NEUTRAL] OK, um, so it's the IMA like igloo, Mary, Alpha.
[AGENT][NEUTRAL] Which is PO Box 2.
[CUSTOMER][NEUTRAL] So it's not to 90 degree?
[AGENT][NEUTRAL] 90 Degree and IMA is the same thing. IMA is just a reprocessing service or
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So it's 90 degrees and that is with IMA right, so if I just put IMA it'll go to y'all, right?
[AGENT][NEUTRAL] Um, it, yeah, it needs to say IMA that's our repricing service, so they'll, um, handle the claim, try to get.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I'm sorry, you're breaking up. hello, can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, there you go. OK, so yeah, OK, so I'll just put that on there alright well I appreciate it and um who am I speaking with?
[AGENT][NEUTRAL] My name is [PII]. First initial and my last name is [PII].
[CUSTOMER][POSITIVE] Alright, Ms. [PII], I appreciate it thank you so much for giving us a call.
[AGENT][NEUTRAL] You're welcome. And what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII]. Have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Thank you, you can see, it's just very difficult.
[AGENT][NEGATIVE] Anytime they give you pushback, just tell them to call my insurance, just call my insurance.
[CUSTOMER][POSITIVE] OK. OK. I appreciate your helpful.
[AGENT][NEGATIVE] So that because that can be so frustrating, especially when you don't feel good, like that's the last thing you want to deal with.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, right. And that's, that's exactly how I'm going, so I appreciate that for sure. And um I understood it sounds like there no insurance cost is 150, so it just
[CUSTOMER][NEUTRAL] $75 will go towards that and then anything else that I get done I'm just pay out of pocket for.
[AGENT][NEUTRAL] Well, I, so that's what I was trying to explain to her. So when, when they send the claim to IMA, um, IMA does repricing, so they're going to try to see if there's discounts that they could apply or how what they can do to get the balance down. If they're unable to, then yes, the, the difference would be, um, could be your responsibility.
[CUSTOMER][NEUTRAL] OK, so I don't pay anything. It's OK.
[AGENT][NEUTRAL] Yeah, I wouldn't pay anything until you receive, if you receive a bill.
[AGENT][NEUTRAL] But that'll be like after they bill insurance and everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, so don't pay anything there. I just want them to bill the insurance. OK, got it, perfect.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that is perfect. Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. I hope you feel better and have a good day.
[CUSTOMER][POSITIVE] Thank you. Thank you. You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.