AccountId: 011433970860
ContactId: 2f7c5290-127c-4103-999c-6aca21341c09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235429 ms
Total Talk Time (AGENT): 119515 ms
Total Talk Time (CUSTOMER): 96846 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/2f7c5290-127c-4103-999c-6aca21341c09_20250114T17:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Texas Health Center for Diagnosis and Surgery. I, um, need to verify what kind of plan a patient has and check their benefits basically and authorization requirements for an upcoming procedure.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you, [PII]. What is a good callback number, please?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][POSITIVE] Thank you, [PII] and the policy number for the patient, please.
[CUSTOMER][NEUTRAL] 02463333.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you, and it would be a pleasure to assist you with eligibility and benefits and authorization information for [PII].
[AGENT][NEUTRAL] I am showing her policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy to her primary insurance.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what type of benefits are you needing? Are they specific benefits? You said she was coming in for a procedure?
[CUSTOMER][NEUTRAL] Uh, so she's scheduled, yeah, she's scheduled for an outpatient hospital surgery, um, so I know it's secondary. I needed to see if like her plan has like a deductible or out of pocket that she needs to meet, um, and then also like if it has pre-op requirements I can give you the surgery CPT code if you need it.
[AGENT][NEUTRAL] I can help you with that. I don't need those procedures as we're secondary, we don't require prior authorization. We do follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she does have outpatient coverage up to $1000 per calendar year. There's no deductible co-pay or co-insurance on this plan. This pays towards her deductible co-payer coinsurance of her major medical.
[CUSTOMER][NEUTRAL] OK, and does she have to file the claim with you guys or do we file it?
[AGENT][NEUTRAL] We do accept assignment of benefits. We pay the provider if the provider files the claims, and also any, if you would please note that all benefits given over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, so, um, the plan will pay up to $1000 per calendar year to the provider directly once the claim is received, um, and has she met any of that $1000 yet or, uh, is it still fully available?
[AGENT][NEUTRAL] It is available at this time. She has not used any of that [PII] benefit.
[CUSTOMER][NEUTRAL] OK, got you, um, and then I want to verify I have the right claims address. It's [PII]. Is that right?
[AGENT][NEUTRAL] That is correct. Uh you can also fax direct claims directly to our claims department. We will also need the EOB.
[CUSTOMER][NEUTRAL] OK, and that fax number was [PII]?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][POSITIVE] OK perfect and uh can I get your name again please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Thank you and is there a reference number for our call?
[AGENT][POSITIVE] The reference number would be my name in today's date, and I spell my name [PII]. And [PII], it was a pleasure to assist you with those benefits. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's gonna be it thank you so much appreciate it.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Thank you, bye.