AccountId: 011433970860
ContactId: 1a71bd23-a233-4a0f-ad76-1f874affff6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233600 ms
Total Talk Time (AGENT): 87339 ms
Total Talk Time (CUSTOMER): 114635 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/1a71bd23-a233-4a0f-ad76-1f874affff6f_20250218T18:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on behalf of Sky Ridge Medical Center, and I need you to verify eligibility and benefits please for a patient.
[AGENT][NEUTRAL] OK [PII], I can help you with um eligibility and benefits. Uh, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] [PII] and the policy number I have is 02580146.
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. She has a supplemental insurance. It's a gap insurance that helps with the deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $5000 and an outpatient calendar year benefit amount of $1000.
[CUSTOMER][NEUTRAL] So does that mean that the plan pays the 1st 1000?
[AGENT][NEUTRAL] No, this is billed secondary to the primary, so the primary is billed first.
[CUSTOMER][NEUTRAL] Yeah, I, I understand we got the primary information, so I'm saying when we build the secondary insurance, you guys are only covering up to $1000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, I'm still playing pay 1000.
[CUSTOMER][NEUTRAL] After primary insurance then patient responsible, the patient responsible for all charges, right?
[AGENT][NEUTRAL] We don't give patients.
[CUSTOMER][NEUTRAL] I mean, will remain the balance.
[AGENT][NEGATIVE] Right. We don't give patient responsibility.
[CUSTOMER][NEUTRAL] So after the 1000.
[CUSTOMER][NEUTRAL] No, so I'm asking, I'm, ma'am, I'm asking you, when the, after you, so this plan, this particular supplement plan that the patient has with American Plan, uh, life or whatever the name American Public Life, this insurance.
[CUSTOMER][NEUTRAL] You said, I'm asking you.
[CUSTOMER][NEUTRAL] Well, how do you guys, so you're, you said that y'all pay the 1st $1000 correct?
[AGENT][NEUTRAL] We pay up to $1000 yes, for outpatient.
[CUSTOMER][NEUTRAL] Up to $1000 for outpatient services and after the $1000 y'all are not gonna pay anything else correct?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Is that a whole year or per service?
[AGENT][NEUTRAL] That is for a year.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I'm not, not that, OK, so then we have claims going to [PII].
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] And is there a group name or a group number?
[AGENT][POSITIVE] Yes, I can give that to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 19874.
[AGENT][NEUTRAL] And the group name is Questco.
[CUSTOMER][NEUTRAL] Q U E S T C O
[AGENT][POSITIVE] CO. Yes, that's correct.
[CUSTOMER][POSITIVE] Awesome. Great. Thank you so much. I really appreciate all of your help. You have a great day.
[AGENT][POSITIVE] You have a great day too, and thanks for calling APL Kalima. Thanks.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] You