AccountId: 011433970860
ContactId: 33827668-df32-41d0-89b3-a26317b94faa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402519 ms
Total Talk Time (AGENT): 172055 ms
Total Talk Time (CUSTOMER): 187631 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/33827668-df32-41d0-89b3-a26317b94faa_20250613T13:21_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] Yeah, hi, [PII]. My name is [PII]. I'm calling you from a provider's office. That's Doctor [PII] at the University of Miami. I wanted to get um eligibility and benefits on a patient.
[AGENT][NEUTRAL] OK, well, I can help you with both the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. My phone number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number? I'm sorry.
[CUSTOMER][NEUTRAL] And my
[CUSTOMER][NEUTRAL] OK, I was like, what did you ask? Sorry, it's Friday, it's Friday.
[AGENT][NEUTRAL] It's Friday, yeah.
[CUSTOMER][NEUTRAL] OK, the number is 02611482.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I have the number here.
[CUSTOMER][NEUTRAL] Now this is considered a gap insurance correct?
[AGENT][NEUTRAL] Um, let me see what type of policy they have. Hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, let me verify first. Can you verify the first and last name and date of birth? I'm sorry.
[CUSTOMER][NEUTRAL] That's OK. His first name is [PII] Last name is [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, yes, this is the secondary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's considered like a gap insurance.
[AGENT][NEUTRAL] Right, and we pay towards the copay, deductible and co-insurance of coverage charges after primary?
[CUSTOMER][NEUTRAL] I've never worked with gap insurance.
[CUSTOMER][NEUTRAL] Uh-huh. OK, so what is um.
[AGENT][NEUTRAL] I am showing this
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] I am showing the policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] He is going to be admitted as an outpatient, not admitted, I should say it's, it's an outpatient um on [PII].
[AGENT][NEUTRAL] Outpatient surgery?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so the um policy will pay up to $6500 per calendar year per person towards um outpatient services. Did you want me to see if any of the 6500 has been used for this year?
[CUSTOMER][NEUTRAL] Yes, give me a second though so I can write this. So, um, you will pay up to what, 6000?
[AGENT][NEUTRAL] $500.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK for.
[CUSTOMER][NEUTRAL] Calendar year OK.
[AGENT][NEUTRAL] And for [PII], he has not used any of the benefits, so he still has that full balance.
[CUSTOMER][NEUTRAL] OK, for [PII] has not used.
[AGENT][NEUTRAL] Any outpatient benefit.
[CUSTOMER][NEUTRAL] I'm sorry, repeat it.
[CUSTOMER][NEUTRAL] OK, any.
[CUSTOMER][NEUTRAL] Outpatient procedures correct?
[AGENT][NEUTRAL] Correct. Well, outpatient in general, he hasn't used any of his benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't know what to ask because I've never worked with the gap insurance, so help me out here. OK, so you pay up to $6500 per calendar year and for [PII] has not used any outpatient procedures. Does he have a deductible under this plan?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] So, instead of saying out because I don't want to confuse things, just say outpatient benefits because that covers everything and lets them know he has the whole total.
[CUSTOMER][POSITIVE] OK, better outpatient benefits. There you go.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Oh, outpatient benefits.
[CUSTOMER][POSITIVE] You see, when I call the insurances like United Healthcare, I know what to ask, but with the gap insurance I don't, so your help is appreciated.
[AGENT][POSITIVE] You're very welcome. That's what I'm here for.
[CUSTOMER][POSITIVE] Thank you. Now what else do I need so I can get this.
[AGENT][NEUTRAL] Um, OK, so do you have like the, I don't know, did they give you the card? Do you have the claims information like to submit a claim, the mailing address, fax number, payer ID?
[CUSTOMER][NEUTRAL] Well yeah that that part um I don't submit the claims the university because I work for the university they'll know because we have all that information in there um is there um let's see.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does he have a deductible with this plan or is that is that is that how it works?
[AGENT][NEUTRAL] Um, some of them do. Let me see if this one, usually they don't though. Let me see, hold on one moment. I'll double check it for you.
[CUSTOMER][NEUTRAL] Then my guy.
[AGENT][NEUTRAL] Um, no, I'm not showing a deductible. There's no deductible on the secondary policy.
[CUSTOMER][NEGATIVE] No, did not. OK.
[CUSTOMER][NEUTRAL] No out of pockets, no nothing.
[AGENT][NEUTRAL] Um, we, so there's no out of pocket for us, that's more primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You see, I don't know what to ask. I'm just asking.
[AGENT][NEUTRAL] So basically, after, um, after you guys bill to primary, primary is gonna apply, you know, based on their policy. If there's anything left over, you're going to bill it to us automatically. If the patient pays a co-pay or deductible to have the surgery, once we receive that claim on the back end, they could be reimbursed out of that $6500 or if there's something still owed to you all after primary pays, we can pay up to that $6500. It just depends on what's left over after primary.
[CUSTOMER][NEUTRAL] OK. Do, uh, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, OK, and um I don't know what else to ask.
[CUSTOMER][NEUTRAL] Is there any way that can you fax me this information? Would you be able to do that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not for medical, um, there's, there's really like no breakdown or anything. There's really nothing else to, I mean, that's really all the information. Once billing gets it, they'll go ahead and bill us.
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] OK, alright, alright, so you, alright, [PII], thank you very much. Can I have a reference number to this call?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and it's [PII]?
[AGENT][NEUTRAL] Um, 2.
[CUSTOMER][POSITIVE] And [PII] and today's date [PII]. OK, great, and thank you very much for your help. I appreciate it. I don't know what else to ask, so I guess I'll just take it from here.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it for now. Thank you very much. I appreciate your help. You have a great day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You also have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[CUSTOMER][POSITIVE] Thanks, dear. Bye-bye.