AccountId: 011433970860
ContactId: 248f2646-0f32-4101-94e9-33a964bf4a26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336760 ms
Total Talk Time (AGENT): 176872 ms
Total Talk Time (CUSTOMER): 126994 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/248f2646-0f32-4101-94e9-33a964bf4a26_20250422T16:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Um, hi, I received, um, y'all's information from a patient of ours that's coming in for surgery tomorrow, and she said that she has y'all as a secondary. So I was just trying to verify that and get any information on it if I could.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. I'll be glad to help you, but go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] My name's [PII] and the policy number is 02479216 for [PII].
[AGENT][NEUTRAL] Alright, thank you, [PII] for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, thank you, [PII] for all that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] All right, [PII], thank you for all that information. Looks like [PII] is the insured on this medical supplemental plan to show the original effective date is [PII]. Patient is active and current, but I must advise that verification of coverage is not a guarantee your payment on a claim, but you did say you want some type of benefit. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry. Could you repeat that? The last part?
[AGENT][NEUTRAL] Yes, ma'am. You did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. What, what is that benefit are you needing today?
[CUSTOMER][NEUTRAL] Um, she's coming in for outpatient surgery, and so we're the facility, we're an ambulatory surgery center. So I would need benefits for, for that type of facility and um as secondary, just kind of how you coordinate with the primary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because what we are, of course, is her medical supplemental plan, so the only thing that we will pay for is for sickness and injury that is applied towards her deductible, co-pay or co-insurance at her primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now let's see her outpatient benefit here is gonna be a no pre-cert, zero deductible, and she has a $3000 benefit payable per calendar year for outpatient hospital services.
[AGENT][NEUTRAL] And what we will need is the actual copy of the original bill along with that primary EOB in order to coordinate any benefit that she might have.
[CUSTOMER][NEUTRAL] So the 3000 you mentioned, that's the max that y'all pay out on her behalf for anything that she owes.
[AGENT][POSITIVE] Per calendar year. Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it could cover part of her deductible or co-insurance like whatever her actual portion from that primary EOB says.
[AGENT][NEUTRAL] Right, it has to apply towards your deductible, co-pay or co-insurance, correct.
[CUSTOMER][NEUTRAL] OK. And can you see if any of that 3000 has been utilized already this year?
[AGENT][NEUTRAL] Let's see what she's used.
[AGENT][NEUTRAL] Yeah, it looks like she has used as of today, she's used $43.50. That's it.
[CUSTOMER][NEUTRAL] OK. OK. Um,
[CUSTOMER][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] What type of policy is it? Like, is it a, like a, a commercial PPO or like a true supplement or what, what is it?
[AGENT][NEUTRAL] No, ma'am, wait, this is a medical supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Medical supplemental plan. And then um um remind me, you, you need a copy of the original EOB and what else?
[AGENT][NEUTRAL] So please.
[AGENT][NEUTRAL] I need a copy of the original bill, along with the primary AOB to be submitted together.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Original bill and then where would that be mailed to?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh mailing address is [PII].
[AGENT][NEUTRAL] Claims department.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And our zip is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, and could I get your name and a call reference number?
[AGENT][NEUTRAL] Yes, ma'am. Is that all that I can help you with today now, [PII]?
[CUSTOMER][NEUTRAL] I believe so.
[AGENT][NEUTRAL] Alrighty. Well, we don't give reference numbers, but you can use my name in today's date, [PII], and my name is [PII], spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, sounds great. Thank you.
[AGENT][POSITIVE] Yes, ma'am, [PII], and thanks for calling APO. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.