AccountId: 011433970860
ContactId: 17a14074-b9b9-46bb-abc2-c791f4a8ff95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437660 ms
Total Talk Time (AGENT): 230063 ms
Total Talk Time (CUSTOMER): 109908 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/17a14074-b9b9-46bb-abc2-c791f4a8ff95_20250116T19:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? Good afternoon. My name is [PII]. Oh. I'm calling because, um, this patient scheduled for surgery on the [PII], um, and I noticed that this is her secondary insurance, um, so I'm just calling to get benefits and see if authorization is required with you guys for this patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you, do you need eligibility as well or just benefits and authorization information?
[CUSTOMER][NEUTRAL] Um, I need benefits and authorization, both.
[AGENT][POSITIVE] OK, so I can help you with all of this, [PII], and what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Thank you, the [PII] direct.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is oh.
[CUSTOMER][NEUTRAL] Hold on, I'm sorry, I just had it up but it's going away.
[AGENT][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEUTRAL] Um, it is 02405750.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so on this policy, uh, let's see, well, first off, any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Birthday is [PII], birthday is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she had been the subscriber on this plan. Uh, this policy, this particular policy number is no longer active. It termed 10-12024, but she does have another policy that is active, effective [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 20
[AGENT][NEUTRAL] And is still active. And that policy number is going to be 02521580.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And give me just a moment please, [PII] to get that information pulled up on the new policy.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and you were needing outpatient benefit, benefits, correct?
[CUSTOMER][NEUTRAL] That's correct hospital outpatient mhm.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar year for covered outpatient services is $2000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so there's no deductible. Is there a copay?
[AGENT][NEUTRAL] There, this is, we are not major medical insurance. This is a supplemental plan to her primary healthcare insurance, so there's no co-pay on this policy.
[AGENT][NEUTRAL] Now when the claim is filed with [PII], we must also have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then once our claim has been processed, you, you should be able to check claim status and also have access to the explanation of benefits for APL by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, great, so is there a cos insurance for the patient?
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] Again, we are not a major medical insurance, so there would not be any type of
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Co-insurance with our company. This plan is designed to help her with her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Co-pays, deductibles, and co-insurance amounts of coverage services. So that's why we have to have a
[CUSTOMER][NEUTRAL] OK, so what was the 2.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] Her maximum outpatient benefit on this supplemental policy is $2000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] For covered outpatient services, that's the maximum this policy would help her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the maximum outpatient benefits and I have a question that 2, 2000, is that what is that the out of pocket or whatever, or that's just the maximum out of outpatient benefit.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That's the maximum outpatient benefit for covered services that the supplemental policy would help with.
[CUSTOMER][NEUTRAL] OK, this this is a supplemental policy that's what it is.
[AGENT][NEUTRAL] Correct. This is not her primary insurance.
[AGENT][NEUTRAL] We are not, yes, ma'am. My company is not a major medical carrier. This is a supplemental policy to her primary health care insurance.
[CUSTOMER][NEUTRAL] OK, so let's put
[CUSTOMER][NEUTRAL] OK, OK, that's the maximum outpatient benefits $2000 for the year. Has she met anything on that yet?
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] For this calendar year, she has not. There have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem, um, thank you so much and it be the
[AGENT][NEUTRAL] And there is no
[AGENT][NEUTRAL] Oh, wait. I tell, give me just one moment to look at one more thing before.
[CUSTOMER][NEUTRAL] As authorization required?
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][NEUTRAL] And actually
[AGENT][NEUTRAL] Yes, ma'am. That, I just wanted to verify as of now, she has not used any of her benefits for this calendar year and because this is a supplement to her primary insurance, [PII], there would not be any prior authorization with us required.
[CUSTOMER][POSITIVE] OK, OK, no problem. OK, thank you so much, [PII]. I appreciate you helping me today.
[AGENT][POSITIVE] Well, you are certainly, you are very welcome and if you need a call reference number for our call today, you would just use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, and what's the first of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, no problem, thank you so much, [PII]. I appreciate you.
[AGENT][POSITIVE] Well, you're very welcome and it was, um, thank you again for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank thank you bye bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.