AccountId: 011433970860
ContactId: 291952e8-79ed-4759-9963-54722da7b9c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288380 ms
Total Talk Time (AGENT): 93316 ms
Total Talk Time (CUSTOMER): 76825 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/291952e8-79ed-4759-9963-54722da7b9c9_20250204T14:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Texas Digestive Disease Consultants, and I just have some questions regarding to this patient's policy.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] 02503207
[AGENT][NEUTRAL] And I get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what questions do you have?
[CUSTOMER][NEUTRAL] Uh, yes, I'm trying to verify if this is a secondary to the patient's medical insurance.
[AGENT][NEUTRAL] To the major medical insurance?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so you're wanting to verify eligibility and verify if this policy is secondary to the major medical policy. It is secondary.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, um, because basically I'm wanting to know if we're gonna send claims to you or if this kind of is like a um third party broker kind of thing where it's like, you know, like, um, Aflac where the patient has to send, um, whatever they owe.
[CUSTOMER][NEUTRAL] To you to get re
[AGENT][NEUTRAL] No, it's a supplemental, it's a Metin supplemental gap plan, so the claim is to be submitted to APL, a secondary payer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do they have any like deductibles or anything or do you just pick up whatever the primary doesn't pay?
[AGENT][NEUTRAL] What type of service is it for? Is it an office visit?
[CUSTOMER][NEUTRAL] She is coming in for a screening, oh no, hold on, I think it's, yeah, a colonoscopy and an EGD which is like a surgery.
[CUSTOMER][NEUTRAL] And the patient has underneath their primary a deductible and co-insurance.
[AGENT][NEUTRAL] OK, so the EGD is for medical concern, the colonoscopy, is it screening or medical concern?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, so she does have the patient has an outpatient benefit under this plan and so those items can be considered under the out outpatient benefit. Let me pull up the schedule.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so I have the outpatient information for you. Uh, the maximum outpatient benefit is up to $1500.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That's per calendar year per covered person.
[AGENT][NEUTRAL] And this, since this is a a supplemental policy, it will reimburse amounts applied towards deductible, co-insurance and or co-pay, um, co-payment, um, charges only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is this the 1500 only for um surgery? What about office visits?
[AGENT][NEUTRAL] One moment, I'll check.
[AGENT][NEUTRAL] All right, so treatment in the office can be considered, but the physician office visit fee is not covered.
[CUSTOMER][NEUTRAL] OK, so office visits are not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK great and I'm sorry, what was your name?
[AGENT][NEUTRAL] You'll use my name and my my name in today's status reference for your call [PII].
[AGENT][NEUTRAL] ONYA.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] First initial last name is [PII].
[AGENT][NEUTRAL] And any other questions, [PII], I can help out with today?
[CUSTOMER][POSITIVE] No, that'll be it thank you.
[AGENT][POSITIVE] Oh you're welcome thanks for calling APL. Have a good day.