AccountId: 011433970860
ContactId: 210a527f-b663-4451-a819-7ea64840593c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317500 ms
Total Talk Time (AGENT): 144789 ms
Total Talk Time (CUSTOMER): 143462 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/210a527f-b663-4451-a819-7ea64840593c_20250520T15:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I have a patient coming into our facility tomorrow and he's stating that he's got you guys as secondary insurance, so I'm just trying to get eligibility and benefits um with you guys and what you guys cover.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely. I'm happy to check benefits and eligibility. What is their policy number?
[CUSTOMER][NEUTRAL] Um, it is 026217-09.
[AGENT][NEUTRAL] All right, thank you. And then for documentation, if I could grab your first name please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and then just date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you. So patient is active. The effective date on here is gonna be [PII]. We are secondary. Is the patient coming in for an office visit with a physician or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, he's coming in for surgery, cataract surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so their outpatient benefit max on this plan is a calendar day and the max is 500.
[AGENT][NEUTRAL] It's gonna pick up any deductible, co-pay, co-insurance of primary does not.
[CUSTOMER][NEUTRAL] So it's a $500 max per day so each visit y'all give him $500 500 dollars y'all pay up to $500.
[AGENT][NEUTRAL] Right, yeah, per day. Uh-huh. Yup.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, is there any like out of pocket like the max you pay up to a certain?
[AGENT][NEUTRAL] Um, the max would just be the $500 per day for any outpatient services. The inpatient is a benefit max for the calendar year, which is $3000. There's no deductible or anything on this plan.
[CUSTOMER][NEUTRAL] OK, but for outpatient it's just the $500 that y'all cover up to and he hasn't it it's just each time, OK, usually there's like a a amount to like per calendar year y'all pay up to $3000 or $4000. This is weird to me, you know, I'm so used to that so I'm just like, OK, this is kind of making sure and then um he gave me this is a American Public Life, is that the name of you guys?
[AGENT][NEUTRAL] But I
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] I gotcha.
[AGENT][NEUTRAL] Yes, ma'am, uh-huh, and I can give you claims mailing address, payer ID, whatever you need.
[CUSTOMER][NEUTRAL] Yeah, if you don't mind giving me the um the yeah address to mail the claims that would be great.
[AGENT][POSITIVE] Absolutely. So it's gonna be American Public Life, and we're at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip code is gonna be [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 31 you say [PII]?
[AGENT][NEUTRAL] Yeah, [PII]. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright perfect and then can I go ahead and get that payer ID as well?
[AGENT][NEUTRAL] Yeah, absolutely. Payer ID is 60801.
[AGENT][NEUTRAL] And we do have fax also if you want the fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah that'd be great.
[AGENT][NEUTRAL] Yeah, absolutely. It's 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, so, um, OK, so no deductible, no copay. I'll pay up to the he's got $375 copay with his primary with Cigna, so you guys will up to the $500 so that way he will not owe that. I've got that and then he gave me the group number 25469. I need to put that in there as well.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me double check that 25469.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] 2, 25469 is correct, yep.
[CUSTOMER][NEUTRAL] OK, perfect. And were you guys ever at the [PII] like [PII] because we had like an old address. Was that is that ever where you guys were at one time?
[AGENT][NEUTRAL] Yeah, [PII], that was the old one, so the [PII] is the, yeah, it's the updated one.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I see y'all finally because I was like what in the world? OK, I can update that. OK, well if I could just get a call reference that was all that I needed today.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial in today's date. My name again is [PII], that's [PII] My last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Alrighty well thank you sir I appreciate your help.
[AGENT][POSITIVE] My pleasure. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too alrighty.
[AGENT][NEUTRAL] Mhm. Bye-bye.