AccountId: 011433970860
ContactId: 2ce8dd66-8055-418d-adc0-8107e6e5fd0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267690 ms
Total Talk Time (AGENT): 134676 ms
Total Talk Time (CUSTOMER): 118352 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/2ce8dd66-8055-418d-adc0-8107e6e5fd0c_20250507T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm sorry, your name again was what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], this is [PII] at Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] I need some help understanding what this plan does for the patient that we're seeing um our billing team flat out says that they're not going to file it because it's not a medical plan, but what I understand from the patient that it assists her in her high deductible. So can you give me some highlights of what the plan does so I can forward it on.
[AGENT][NEUTRAL] We can help you. And spell your first name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], OK, and what's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, policy number is 02586839. Phone number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So this is a supplemental gap plan. It is secondary to the major medical plan. Now, is the service in an office setting or is it an outpatient facility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In office setting.
[AGENT][NEUTRAL] OK, so the physician's co-pay is not covered, but if there's covered treatment in the office, this policy can review those charges.
[AGENT][NEUTRAL] For payment.
[CUSTOMER][NEUTRAL] OK, so all of hers goes towards the deductible.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And she has a high deductible.
[AGENT][NEUTRAL] Right. So if it's treatment in the office.
[AGENT][NEUTRAL] And when the primary processes the claim, it goes towards her calendar deductible. this policy will uh pick up the amount that's applied towards deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, of covered charges and let, let me give you that amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So it's a supplement type policy.
[CUSTOMER][NEUTRAL] You said it's a it's a a subca plan. What does that mean?
[AGENT][NEUTRAL] It's a supplemental gap policy. It supplements the major medical. Mhm, mhm.
[CUSTOMER][NEUTRAL] OK, gap, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up the benefit.
[AGENT][NEUTRAL] And what type of treatment is it for?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She's uh coming to an orthopedic surgeon, so it's office visit, X-ray injection, that type of thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] So under her plan, the inpatient and outpatient benefit is combined for a maximum of up to $2100 and that is per covered person per calendar year.
[AGENT][NEUTRAL] And let me see if any of that has been used. I don't show any claims for her for [PII], and of course the information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so that
[CUSTOMER][NEUTRAL] So what they need, what the billing team needs to do is they need to have a 1500 form attach the original EOB from the primary and send it to you by paper, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me make sure that there's no deductibles. Give me a second under this policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I do also see a deductible of $1000 per person per calendar year. So, uh, in this instance there will not be a benefit paid until she meets this deductible as well so it's gonna be.
[CUSTOMER][NEUTRAL] OK, has she met any?
[AGENT][NEUTRAL] She has, she doesn't have any claims on file so it's not satisfied yet. Mhm.
[CUSTOMER][NEUTRAL] OK, no claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][NEUTRAL] Alright, and this is not a policy that you have to be participating in by the doctor.
[AGENT][NEUTRAL] So we follow the major medical, so there's not a network of contracted providers if that's what you're asking.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][MIXED] Because that's what they're wanting, they're wanting me to say that we're participating. I said it is not that type of a plan, so that's why I'm very frustrated with them. OK, thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] You're correct.
[AGENT][POSITIVE] You're correct.
[AGENT][NEUTRAL] All right, [PII], anything else?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.