AccountId: 011433970860
ContactId: 1cb6de6d-7f52-4807-8b8e-da5c6d404984
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429170 ms
Total Talk Time (AGENT): 153353 ms
Total Talk Time (CUSTOMER): 199814 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/1cb6de6d-7f52-4807-8b8e-da5c6d404984_20250509T17:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Blue Cross Blue Shield of Texas. I'm calling back for eligibility questions.
[CUSTOMER][NEUTRAL] And mainly and coordination of my ass, OK.
[AGENT][NEUTRAL] OK, um, what is your name again, please, ma'am, and can you spell it for me?
[CUSTOMER][NEUTRAL] Yes, just a second, yeah, my first name is [PII]
[AGENT][NEUTRAL] Thank you and Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Can I put you on hold for a second, a second, just a second. Is that OK?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, thank you. Yes, let me give you the phone number. Can you thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Because my cat was crying. I had to call her. Sorry about that.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So I callback number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the name of the patient, their date of birth, and the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Definitely. OK. Her first name is [PII], her last name is [PII], and her date of birth is [PII], and I can ask her for her policy number. I have her on the back line.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] One moment, let me ask you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, thank you. So, um, are you ready for the policy number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] It's 02572570.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, and I do show that [PII] does have an active policy. Her effective date of the policy is [PII], and there are no coordination of benefits. This is a supplemental insurance policy.
[CUSTOMER][NEUTRAL] OK, this is where we are lost because so it is no what do you mean by supplemental policy because they told me that it falls under like group indemnity, so it doesn't fall under this one it's a supplemental policy, correct?
[AGENT][NEUTRAL] Right, and this is just to verify benefits. It's not a guarantee of payment. This policy is a supplemental that's billed secondary to the primary, but it only helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So what do you mean by that? So you don't, so we don't, the, the provider doesn't have to submit claims to you, correct? They don't submit claims to you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] No, the provider does submit claims to us, but we don't do coordination of benefits.
[AGENT][NEUTRAL] It's a standalone policy.
[CUSTOMER][NEUTRAL] A standalone policy, so stand alone.
[CUSTOMER][NEUTRAL] Policy, so no coordination of ones so I don't have to add this on file and the providers like, uh, so the provider has has to submit to both like to you and to us is what I'm saying.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and when they submit to us, they need to send the explanation of benefits from the primary with their claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they need to have submit the EOB as a but it's not there is no coordination you you decide um I don't know how it works. This is new by the way.
[AGENT][NEUTRAL] Based on the policy, yes, based on the policy contract and how the policy is written is how we provide benefits.
[CUSTOMER][NEUTRAL] For, for example, the member because it like what's going on with her now, she used to get medical supplies for diabetics from Tander.
[CUSTOMER][NEUTRAL] And she gave them your insurance ID, your card, your information too.
[CUSTOMER][NEUTRAL] And now as secondary what they are doing now, they don't want to give her any supplies because saying that uh like because there's a secondary and they are they are not contracted with you so they don't want her to give her, they don't want to go because both insurances they have to be in network to give her any supplies.
[CUSTOMER][NEUTRAL] But I think
[AGENT][NEUTRAL] OK, so, so this one, this one can be used anywhere she wants to use it. Um, like I said, it only helps with deductible, co-pay or co-insurance, and this is just to verify benefits. It's not a guarantee of payment. She has an inpatient calendar year benefit amount of $3000 to help with deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] And then she also has an outpatient calendar year benefit amount of $1000 to help with deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So you, uh, OK, so it's like even if they are out of network it's not related it's you don't take it's not like uh it's different than what see what I'm saying, even if a provider is out of network like it's not related with in network or out of network because this is a different thing.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, that's correct and if the provider does not want to accept the insurance she can file claims herself.
[CUSTOMER][NEUTRAL] Oh, OK, OK, she can file a claim to you. So this is, I will put no coordination of benefits, but they have to submit the claim to you just to benefit for what you offer. And do you like, do you cover something like medical supplies like durable medical equipment or just for the hospital and
[AGENT][NEUTRAL] Just hospital and outpatient, deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] I understood.
[CUSTOMER][NEUTRAL] Understood. So I don't have to add this to the to the to our information, OK, so can I have your name and the reference number for this call?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII], and you can use my name and today's date for your reference.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate it thank you.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a wonderful day. Is that everything I can help you with?
[CUSTOMER][POSITIVE] No, same to you thank you thank you bye bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye-bye, ma'am.