AccountId: 011433970860
ContactId: 244e05ea-d212-42b0-8248-6b0acaf939fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223589 ms
Total Talk Time (AGENT): 73221 ms
Total Talk Time (CUSTOMER): 116426 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/244e05ea-d212-42b0-8248-6b0acaf939fe_20250423T21:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from Valley Regional. Can you hear me?
[AGENT][POSITIVE] Yes, I can.
[CUSTOMER][NEUTRAL] Oh, OK, it's because I called earlier, but I guess the line got disconnected.
[AGENT][NEUTRAL] Yeah, I, if something was weird on the line, I couldn't hear anything. It was strange. It was like.
[CUSTOMER][NEUTRAL] Oh, straight.
[AGENT][NEGATIVE] Buzzing really loud. I don't know what happened.
[CUSTOMER][NEUTRAL] Oh, OK. No worries. Uh, I just had to get um coverage on a patient. She presented this secondary insurance.
[AGENT][NEUTRAL] OK, uh, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you're needing to get benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah. Uh-huh. It's 02.
[CUSTOMER][NEUTRAL] 431,080.
[AGENT][NEUTRAL] And what was that patient name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth is [PII]. I just wanna make sure that this isn't one of those plans that pays the patient that they will, if it also pays the facility, you know what I mean?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, we'll do assignment of benefits, absolutely.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, let's see, so not a guarantee of payment, basic outline of the policy. I show the policy is effective [PII]. It's currently active. Is this gonna be for outpatient services at the hospital, or?
[CUSTOMER][NEUTRAL] Uh, outpatient, yes, well, she actually got admitted to the facility under observation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if it's under 18 hours, um, it would be under her outpatient benefit, um, which is $2550 per covered person per calendar year.
[AGENT][NEUTRAL] So this is basically like a secondary policy that will pick up after primary processes the claim, any deductible, co-insurance, co-pay.
[CUSTOMER][NEUTRAL] OK, so like for example I'm just gonna say like for example if she were to have like a $5000 responsibility we would deduct the $2550 from that?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I get it. OK. And this policy would pay the hospital or does it pay the patient?
[AGENT][NEUTRAL] Uh, it'll pay the hospital.
[CUSTOMER][NEUTRAL] It pays the hospital. OK, great. And then, um, I just need to confirm, is there any pre-cert required for these type of plans?
[AGENT][NEUTRAL] No, no pre-cert, no prior off.
[CUSTOMER][NEUTRAL] Pretty sure required or prior off.
[CUSTOMER][NEUTRAL] And do we submit the claims to the [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Do you by any chance do you have an electronic payer ID number?
[AGENT][NEUTRAL] Yes, we do. It's 60.
[CUSTOMER][NEUTRAL] Oh, never mind. I saw it. I, I saw it. My bad. I didn't see it, [PII]. 60801.
[AGENT][NEUTRAL] OK, got it.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. And the initial to your last name?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Do I get a good call reference number?
[AGENT][NEUTRAL] Uh just my name and today's date.
[CUSTOMER][POSITIVE] OK great thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good evening.
[CUSTOMER][NEUTRAL] You too bye bye.