AccountId: 011433970860
ContactId: 2b083273-eb83-4958-9844-98a7d4f05eab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600169 ms
Total Talk Time (AGENT): 199354 ms
Total Talk Time (CUSTOMER): 166397 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/2b083273-eb83-4958-9844-98a7d4f05eab_20250124T15:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is so. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, thank you. Good morning. This is [PII]. I'm calling from Blackstone Medical Services. I need information about benefits as secondary insurance, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits, Miss [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, no problem, would be [PII].
[AGENT][NEUTRAL] And you said you're calling from which facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the name?
[CUSTOMER][NEUTRAL] It's Blackstone Medical Services.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number Mrsiana?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, I got here 10677896 letter M and L as in Lima M as in Mary and L as in Lima M8.
[AGENT][NEUTRAL] OK, I got too many numbers and too many letters. Um, do you have the copy of the card?
[CUSTOMER][NEUTRAL] No, I'm so sorry I don't have that ID card.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] How do you spell the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what type of service is being rendered for this member?
[CUSTOMER][NEUTRAL] Um, I need information about benefits.
[AGENT][NEUTRAL] What, what type of food?
[CUSTOMER][NEUTRAL] I got here
[CUSTOMER][NEUTRAL] Yes, it's home as leave a study benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I I.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And Ms. [PII], is this uh facility uh affiliated to any hospitals?
[CUSTOMER][NEUTRAL] I'm sorry, uh, did you repeat that please?
[AGENT][NEUTRAL] Is this facility affiliated to any hospitals?
[CUSTOMER][NEUTRAL] Uh, let me check that information.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure, yes.
[CUSTOMER][NEUTRAL] Thank you. Uh, no, we don't.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] So it's a freestanding facility?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Bear with me just a second, let me pull um the information of the sleep study centers. OK, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you, sure, no problem.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you mind holding for me, Mr. [PII]?
[CUSTOMER][POSITIVE] Yes, no problem, sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Ms. [PII]. OK, I went ahead, I got the information for you. So it looks like, and this is not a guarantee of payment, just a verification of coverage. It looks like it will be considered under the outpatient maximum, which is 5000 per cover person per calendar year.
[CUSTOMER][NEUTRAL] 4000, right?
[AGENT][NEUTRAL] Uh, 5000 per cover person per calendar year.
[CUSTOMER][NEUTRAL] I'm sorry, 4000.
[AGENT][NEUTRAL] 5.
[CUSTOMER][POSITIVE] 5. Thank you.
[AGENT][POSITIVE] 5000. Mhm. You're welcome.
[CUSTOMER][NEUTRAL] And how much is the co-insurance?
[AGENT][NEUTRAL] Oh no, we are the secondary policy to the major medical. We're not the major medical. This is a secondary supplemental plan. Um, we help with the deductibles, co-payment and co-insurance from the major medical. So the maximum benefit is 5000.
[CUSTOMER][POSITIVE] Perfect thank you so much and uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You say is a supplemental plan, so what is the plan?
[AGENT][NEUTRAL] No, this is a secondary supplemental to the major medical.
[CUSTOMER][NEUTRAL] Uh, I mean, do you have any letter for the plan, plan GMF any?
[AGENT][NEUTRAL] No, we're not, we're not Medicare, we're not Medicaid. We're, we're, we're just a secondary supplemental plan to the major medical, to any major medical. Mhm.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I understand, and, uh, for this benefit, a secondary authorization would be required.
[AGENT][NEUTRAL] No, we follow primary.
[CUSTOMER][POSITIVE] Thank you so much. May I have the group number for this policy, please?
[AGENT][NEUTRAL] The group number? OK, let me get that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, the group number is 16257.
[CUSTOMER][POSITIVE] Thank you so much and may I have the pay ID?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, this one is a secondary policy, so it needs to be fax or mail for a claim because it needs the AOB from the primary insurance attached to it.
[AGENT][NEUTRAL] Um, I can give you the payer ID for your records. The claim needs to be faxed or mail, OK? Uh, the payer ID is 60801.
[CUSTOMER][NEUTRAL] It's the same for the claim address right?
[AGENT][NEUTRAL] The claim address is PO Box 248,950 Oklahoma City, Oklahoma and the zip code is [PII].
[AGENT][NEUTRAL] Which it should be in the card.
[CUSTOMER][POSITIVE] OK perfect thank you so much so it's possible that you can give me the correct ID number please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the correct policy number for this number is 0167.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] 7896.
[CUSTOMER][NEUTRAL] 96 perfect thank you and could you remember me your name last name and call reference number please?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much and the call reference please.
[AGENT][NEUTRAL] My name [PII]ay's date, we don't have reference numbers.
[CUSTOMER][POSITIVE] So thank you so much for the assist today you are so kind.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] Um, no, that is all for now, thank you.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] You're welcome. Have a good day and thank you for calling ATL, Mr. [PII].
[CUSTOMER][POSITIVE] You too. Goodbye. Thank you.
[AGENT][NEUTRAL] Yeah.