AccountId: 011433970860
ContactId: 27b232a2-e296-42ff-9b91-08fcc9f2c66a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339769 ms
Total Talk Time (AGENT): 136552 ms
Total Talk Time (CUSTOMER): 137238 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/27b232a2-e296-42ff-9b91-08fcc9f2c66a_20250401T17:33_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] Hi, I have a question for you. Um, we are a provider, we're a hospital, John Muir Hospital in [PII], and I have was given an insurance card by one of your subscribers. Um, she was admitted here through emergency, through, uh, for labor and delivery, and she's given birth.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would this be the proper person that I speak to here?
[AGENT][NEUTRAL] Yes, so you just need to go over eligibility and benefits.
[CUSTOMER][NEUTRAL] No, I know that she's covered um I did that online, but I want to report her admission here please.
[AGENT][NEUTRAL] Like an authorization?
[CUSTOMER][NEUTRAL] Yeah, so do you require an authorization for labor and delivery? The baby was born well.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] We don't require um any prior prior authorization or pre-cert.
[AGENT][NEUTRAL] I just want to make sure I understood what you were asking for. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, no, that's great, um, OK, no problem, so no clinicals need to be faxed?
[AGENT][NEUTRAL] Correct, um, just the
[AGENT][NEUTRAL] You know, the documents for the claim whenever you're filing the claim, the um explanation of benefits. I can look over benefits if you need to, but
[CUSTOMER][NEUTRAL] Yeah, um, I mean if you wanna look over and make sure that she's fine with her coverage for LND then um you can and I can be on hold. That's fine. I can give you the policy number, but if not then I can just notate the account that um do you guys follow the 2 to 4 government mandate rule or 35 or?
[AGENT][NEUTRAL] Well, it no, um, but let me see what type of policy they have. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, of course, [PII], phone number is [PII].
[CUSTOMER][NEUTRAL] This is AMR correct?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] This is AMR.
[AGENT][NEUTRAL] No, this is APL, American Public Life.
[CUSTOMER][POSITIVE] American Public Life perfect.
[AGENT][NEUTRAL] And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, member's policy number is 02538043M as in Mary C as in Charlie 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so for the inpatient benefits, she has up to $3000 per calendar year.
[AGENT][NEUTRAL] And did you want to see if she's used any for the year?
[CUSTOMER][NEUTRAL] I don't need to know any of that information. I just need to know if you would like me to report her and her baby in their admission here at our hospital.
[AGENT][NEUTRAL] No, ma'am. Prior authorization is not required for secondary insurance.
[CUSTOMER][NEUTRAL] OK, and how long do they have with uh natural birth and C-section?
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] OK, so she has, um, let's see, she has unlimited bed days is what you're saying?
[AGENT][NEUTRAL] OK, wait a minute. You're asking me about her bad days or about the time to file a claim?
[AGENT][NEUTRAL] So basically, this is our secondary insurance. We're not primary. So no matter how much the bill is, this secondary insurance would only pay up to $3000 towards the whatever the bill total is.
[CUSTOMER][NEUTRAL] Oh interesting yeah I don't have another insurance on file for this patient. This is the only insurance that she says.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] I can look it up for you, hold on.
[CUSTOMER][NEUTRAL] This is her.
[CUSTOMER][NEUTRAL] Um, notated in her, in her in her chart.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Yeah I think that's where the confusion is.
[AGENT][NEUTRAL] It's coming up. It's just thinking, hold on one moment.
[AGENT][NEUTRAL] OK, so the, let me make sure this is the right group because sometimes it doesn't switch over. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so for the major insurance, I'm showing it's allied benefits.
[CUSTOMER][NEUTRAL] Allied benefits, do you have a subscriber number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, we don't have any of the information other than the name um of the major insurance or major medical.
[CUSTOMER][NEUTRAL] OK, the baby was born yesterday, so I'm gonna, and the baby was born well, so I'm gonna give the mom a call because I was, uh, again because she had let us know that this is her only insurance.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Yeah, no, this is through her employer and so they have the Allied benefits and then our policy pays towards the copay, deductible and co-insurance after Allied benefits.
[AGENT][NEUTRAL] Up to that calendar year max, which was
[AGENT][NEUTRAL] I think 3000.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, it was 3000.
[CUSTOMER][NEUTRAL] OK, I will give, I will give mom a call.
[AGENT][NEUTRAL] OK. All right, well, was there any
[CUSTOMER][POSITIVE] I appreciate
[AGENT][POSITIVE] You're welcome. Well, thank you for calling APL G. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you very much now, bye bye.
[AGENT][NEUTRAL] Bye bye.