AccountId: 011433970860
ContactId: 3008cef2-affe-4a76-b79a-7ddc5fed05c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638690 ms
Total Talk Time (AGENT): 372657 ms
Total Talk Time (CUSTOMER): 270922 ms
Interruptions: 8
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/3008cef2-affe-4a76-b79a-7ddc5fed05c8_20250523T13:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. We're the provider. I'm a patient eligibility and benefits, please.
[AGENT][NEUTRAL] OK, you're needing excuse me, eligibility and benefits for one member, [PII], is that correct?
[CUSTOMER][NEUTRAL] As of now, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] OK, let me see. 02465840 ML 7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Well, give me a couple of moments please to get the member's information pulled up.
[AGENT][NEUTRAL] And what is any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, this policy, I need to give you a different policy number because this policy is not an active policy. It's almost like it was never active. It went into effect and turned the same date, so let me give you another number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Oh, is it? Hold on, let me see. What did I give you? Oh my and that's what they gave, and that's the card they scan and they get in the wrong card. Oops, the patient probably gave gave the wrong card.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so this policy number, the policy number that you need to have for this number is going to be 01659812.
[AGENT][NEUTRAL] And this policy has an.
[CUSTOMER][NEUTRAL] OK, 01659812? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, 01659812. I think that's what you said.
[AGENT][NEUTRAL] Is that right? OK.
[CUSTOMER][NEUTRAL] Yes, 01659812. Uh-huh.
[AGENT][POSITIVE] That's correct, yes ma'am. OK.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[AGENT][NEUTRAL] And it is active.
[AGENT][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] When did the other one turn? A long time ago?
[AGENT][NEUTRAL] It was, uh, the other one was effective and termed the same day. Like it was like it was never really active. It had an effective and term date of [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] OK perfect I've seen things like that and it's like one day I've never OK.
[AGENT][NEUTRAL] Yeah, so hold on.
[CUSTOMER][NEUTRAL] Um, does he have, uh, does she, does she have outpatient urgent care coverage?
[AGENT][NEUTRAL] OK, give me just one moment to get the other policy information fully pulled up here.
[CUSTOMER][NEUTRAL] OK give me just one moment to get the.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit max per calendar year for covered outpatient services is $7900.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK, so just to confirm, sorry, so they are covered for that benefit?
[AGENT][NEUTRAL] Urgent care can be reviewed under this outpatient benefit. Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. And this is their, I always confused. Is this their gap plan or supplemental health insurance?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Yes, this is their supplemental policy. Yes, essentially, yes, the same thing. So when the claim is submitted to us for review, [PII], you all must also send us a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Or does that mean the same thing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then once we process.
[CUSTOMER][NEUTRAL] And the billing billing will do that.
[AGENT][NEUTRAL] Yes, just as long as they know that there's that that we have to have that and then the last thing is that once the claim has been processed, if there's a way you can make a note, our portal should be able to be used to access claim status and the website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right, yeah, there's a portal for claims that and people think I've seen people think that they can go verify eligibility on there. I'm like, no, that's only, that's only for claims you gotta call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For eligibility.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's claim status only at this time. Hopefully, in the future, you may be able to do that, but as of now, yes, ma'am, that's claim status.
[CUSTOMER][NEUTRAL] Only, yes.
[CUSTOMER][NEUTRAL] OK, so, so this is right, so tell me one more time, supplemental and gaps the same thing, right?
[AGENT][NEUTRAL] MedLink and supplement, this Medin supplemental, and Gap, yes. Some people call it Gap, some people call it supplemental. We refer to it as a supplemental, essentially, yes. Works in the same manner.
[CUSTOMER][NEUTRAL] So same thing.
[CUSTOMER][NEUTRAL] OK, OK, because what we have to do is I always have to make a note, click a note like where I get credit for what I did. I wanna make sure I'm saying supplemental instead of gap. OK. OK. Thank you, [PII], and [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I would put supplemental.
[AGENT][NEUTRAL] Yeah, put supplemental, uh-huh, yeah.
[AGENT][POSITIVE] Absolutely. C R A C I.
[CUSTOMER][POSITIVE] Oh [PII] you have any fun plans for the long weekend?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Uh, no, just kind of, um, hope, well, plans to do some stuff around my house, but I'm not going anywhere.
[CUSTOMER][NEUTRAL] Oh, OK, and are you off on Monday too?
[AGENT][NEUTRAL] Yes, we are. Uh-huh. Are you all?
[CUSTOMER][NEUTRAL] Yeah, I'm off. I need a break.
[AGENT][POSITIVE] Well, that's good for you. That's good for you. I'm sure the entire clinic won't be closed, but that's good for you that you're off.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, actually, so we are actually closed surprisingly, like we we since we're like a hospital, yeah, they're, they're closed, they're off on Monday.
[AGENT][NEUTRAL] Really?
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEGATIVE] Very shocking. I wouldn't think that, you know, an urgent care would be
[AGENT][NEUTRAL] Closed.
[AGENT][NEUTRAL] Like that.
[CUSTOMER][NEUTRAL] Yeah they're closed.
[AGENT][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] But even if they are open, I have lots of PTO to take, so I want to take some time off to myself it's needed because.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, absolutely.
[AGENT][POSITIVE] Uh, we all need that, [PII], from time to time. I totally understand that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then one more question, are all your plans are supplemental, right? supplemental health plans?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, we, there are different, we offer several, some plans are a limited benefit hospital indemnity plan.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] So there are different.
[CUSTOMER][NEUTRAL] Oh, you do indemnity too, OK.
[AGENT][NEUTRAL] Yeah, we do. Mhm.
[CUSTOMER][NEUTRAL] But there's the deputy ones are those like the supplement those are like supplemental plans as well.
[AGENT][NEUTRAL] Well, they are, but they're, you know, they're, well, they're just a limited benefit plan. You know, they may or may not.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Fifthland, those are very popular.
[AGENT][POSITIVE] They're becoming more popular, yes.
[CUSTOMER][NEUTRAL] And those
[CUSTOMER][NEUTRAL] Yes, and those can be primary, those can be either or, or whatever the member wants to do it, use it as their primary.
[AGENT][NEUTRAL] But it, well, no, it cannot be their primary insurance. A hospital indemnity plan is, well, it is not a we are not a major medical carrier. So even with the hospital indemnity plans, they are just a limited benefit plan.
[CUSTOMER][NEUTRAL] On secondary, OK.
[AGENT][NEUTRAL] Like these gap plans have specific benefits, um, you know, they cover certain services and each of the gap plans are different. It just depends on the offerings that their employer chooses, you know. So.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, right, like United Healthcare, United Healthcare has those have indemnity plans, and say for United, the patient has the option to pick, OK, do you want it to be, you know, it can be either or, right? Do you want to use as your main one or not? Yeah, United gives them the option.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Huh, well.
[CUSTOMER][NEUTRAL] So I always say, you know, I, I always tell people, OK, well this is the card that they scanned in, so this is what they wanna use. So it's like, oh, OK, yeah, when you in healthcare, they give you, they give patients the option.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh wow. Yeah, with us, we tell, you know, like I told you this was a supplemental policy.
[AGENT][NEUTRAL] When I call someone calls me about.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, one of our limited benefit plans, I'll always let them know that, you know, this is not major medical insurance. It is a hospital indemnity limited benefit plan that pays specific amounts for certain covered services. You know, because some of them may have urgent care and some of them don't. I mean, some of them have ER and some of them don't, right? So they're all different.
[CUSTOMER][NEUTRAL] Right, and sometimes I sometimes.
[CUSTOMER][NEUTRAL] Some not, some don't.
[CUSTOMER][NEUTRAL] Right, right, right, now those are very popular, and those are becoming very popular. OK, so this is a supplemental health plan. Actually, I have to tell you.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have to tell you, I, uh.
[CUSTOMER][NEUTRAL] Um, what was I gonna say, you know, I've only seen like the American public supplemental supplemental health plans. I haven't seen really lots, lots of indemnity plans, more so with United Healthcare, not really with you guys.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, a lot of our business that's in [PII], which is a, is a large chunk of our business, has a lot of these meddling. You're gonna see a lot of meddling. Some of the other ones are coming, you know, in, and there's a few, but I would say the majority of them, yes, are gonna be the supplemental policies that help with their co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And Medbank and the Medlik is the supplemental health plan, right?
[AGENT][POSITIVE] Correct. Yes, it is. Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's good to know. OK, and then the the subscriber was [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct, uh huh.
[CUSTOMER][POSITIVE] All right. Thank you so much. You taught me something today. I appreciate you, [PII]. Enjoy your long weekend.
[AGENT][POSITIVE] No, well, you're certain. I hope you do too, [PII], and enjoy that time off that I'm sure is very much needed.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] OK. Thank you so much. Yes, ma'am, and thank you again for calling APL. Bye-bye. Bye-bye.
[CUSTOMER][NEUTRAL] Bye [PII].
[CUSTOMER][NEUTRAL] Bye bye.