AccountId: 011433970860
ContactId: 1d6c0c83-89cd-4ad8-bbe1-813ebbd362c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346690 ms
Total Talk Time (AGENT): 169101 ms
Total Talk Time (CUSTOMER): 162503 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/1d6c0c83-89cd-4ad8-bbe1-813ebbd362c7_20250124T20:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. My name is [PII] Last name [PII]
[AGENT][NEUTRAL] OK, and how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Uh yes ma'am. I've got a patient who um has this policy as their secondary, and I'm needing to know um if it is active and um if.
[CUSTOMER][NEUTRAL] It's secondary so let's just find out if they're active first and we'll go from there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All [PII]. And um [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, it is, um, my phone number is [PII], and that is direct.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, oh, policy number, it is 025644447.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I'm not, I'm not gonna attempt. I'm just gonna spell it. OK, it's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And space and [PII]. I don't know if that's I don't know what that is.
[AGENT][NEUTRAL] OK, it's OK and then just the date of birth.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So yes, I am showing that the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now I, I've got a question. Their primary is called Allied Benefit Systems, and that is active now, um, is this policy, the American Public Life, is this like alan F or a plan G?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Neither, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is just, so basically we pay towards the copay, the deductible and co-insurance after Aetna, which is allied administrative, but it's Aetna. Um, yeah, so I can go over like, did you need particular benefits or anything?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, this patient is going to just be having a screening, uh, colonoscopy, and um I just I'm needing to know if this patient's gonna owe anything when he comes in for um the procedure like is there but you just said that the the Aetna Allied it covers the co-insurance and the deductible correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, other way around. So Aetna charges it, and second, we help pay it. So it depends, so it depends on how you all do as a facility. If there's somewhere like a billing option, then we will handle the co-pay on the back end. If they need to pay first to be seen, then they'll have to pay that and then we can reimburse them, so it depends.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That that's what I meant.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so it's not like this, um, American public life it let me, how do I ask this? Does it cover what the allied benefit systems does not cover?
[AGENT][NEGATIVE] No, if Allied is not applied, we a second cannot be applied.
[AGENT][NEUTRAL] Did I confuse you?
[CUSTOMER][NEUTRAL] Maybe.
[AGENT][NEUTRAL] So, because we're second to Aetna or Aetna and Allied is the same thing, because we're second to them, let's say Aetna um denies the claim, then you submit the claim to us. We're going to deny it also because we're second to them. So if they don't pay to the claim, we can't.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to call them to see if this patient's gonna owe anything and if this patient is gonna have a copay or deductible or co-insurance, then I call you all back to see if you cover that?
[AGENT][NEUTRAL] Mhm. I mean, you, you can call us back if you like, but just
[AGENT][NEUTRAL] So are you, I can give you the benefits now. It doesn't really, the only thing you're going to call Aetna for is to see what the out of pocket or, you know, the co-pay or deductible would be. And if they cover what's being done, if they cover, then you know that we can apply up to like for example, are you out I'm assuming you're outpatient.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, this is outpatient yeah it's just a screening colonoscopy is all it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for outpatient, the um let me see what the benefit is. Hold on one second.
[AGENT][NEUTRAL] OK, so for outpatient it's $750 per calendar year. So once you talk to Aetna and they say, yeah, we'll cover it up to blah blah blah, and this is the deductible and the and the co-pay, then you know we have that $750 for whatever data. Well, it's for the whole calendar year, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, I guess that's all I needed, so now I will call them then.
[AGENT][POSITIVE] You got it.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Uh, no, ma'am, mm mm, nope, you're good.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL Marine. I hope you have a great day and a great weekend. I went completely blank. It's Friday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh good no that's fine. I know. OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] 00, could I get a reference number for this call?
[AGENT][NEUTRAL] Oh, sure. So there's no call reference number, um, but you can use my name in today's date, so that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and then today's date. Alrighty, thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK mhm.
[CUSTOMER][POSITIVE] Thank you bye bye.