AccountId: 011433970860
ContactId: 3494b0c0-ec41-47cf-9167-258dcee40e93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355100 ms
Total Talk Time (AGENT): 110829 ms
Total Talk Time (CUSTOMER): 144236 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/3494b0c0-ec41-47cf-9167-258dcee40e93_20250429T19:27_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 afternoon. My name is [PII]. I'm with Critical Care and Pulmonary Consultants in [PII]. I'm trying to verify, um, a patient's insurance, um, for services we recently provided care to.
[AGENT][NEUTRAL] Hi, [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And is it [PII] or?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] ANY, OK.
[AGENT][NEUTRAL] And do you have the policy certificate number of the patient?
[CUSTOMER][NEUTRAL] I have 02573210.
[AGENT][NEUTRAL] No patient.
[CUSTOMER][NEUTRAL] With the group number 19874.
[AGENT][NEUTRAL] OK, uh, patient.
[CUSTOMER][NEUTRAL] It's for [PII], and my services started on the [PII] or [PII] and ended on the [PII].
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] You have her date of birth?
[CUSTOMER][NEUTRAL] I have let me look here.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you were wanting to check the benefits?
[CUSTOMER][NEUTRAL] I wanna, yeah, and find out if this is this uh a commercial plan or what type of plan is it?
[AGENT][NEUTRAL] Does she have outpatient services or inpatient or what type of services?
[CUSTOMER][NEUTRAL] Uh, she was hospitalized what I can see, but let me check and I'll tell you if she was obs or inpatient.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I think she was admitted as an inpatient, but let me make sure.
[CUSTOMER][NEUTRAL] And our services are professional services in a hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just haven't heard of your insurance before.
[AGENT][NEUTRAL] Yeah, it's a secondary like gap plan um so it kicks up after primary, yeah.
[CUSTOMER][NEUTRAL] Oh, is it?
[CUSTOMER][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] She was inpatient, so you're a supplement then.
[AGENT][NEUTRAL] Yes, so after, and it's not a guarantee of payment, basic outline of the policy, um, for inpatient benefit.
[AGENT][NEUTRAL] Uh, looks like there's a 5000.
[CUSTOMER][NEGATIVE] No it's professional services.
[AGENT][NEUTRAL] OK, um, yeah, I.
[CUSTOMER][NEUTRAL] It's for doctor.
[AGENT][NEUTRAL] OK, yeah, I don't, I don't think it it includes that. Let me double check. That's what I'm checking, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like they don't cover physician office visits.
[AGENT][NEUTRAL] Um, but they would cover looks like up to 5000 per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but like I said, office visits aren't part of that, so.
[CUSTOMER][NEUTRAL] OK, this is hospital visits, so you would cover, so it's a limited plan.
[AGENT][NEUTRAL] Yes, so after the primary processes the claim, whatever is left over, potential deductible, co-pay, co-insurance, they have a benefit that covers up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK, and do I have the correct ID number?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And is it an active policy?
[AGENT][NEUTRAL] Yes, policies are effective [PII] currently active.
[CUSTOMER][NEUTRAL] OK, and the claims go to [PII] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I'm sorry, 24.
[CUSTOMER][NEUTRAL] [PII] or [PII]?
[AGENT][NEUTRAL] Oh it's, it's [PII].
[CUSTOMER][NEUTRAL] Right, I understand the zip code.
[AGENT][NEUTRAL] OK, zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is there a group number that we need as well?
[AGENT][NEUTRAL] The group number is 19874.
[CUSTOMER][NEUTRAL] Is there a payer ID number?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] OK, and is there a fax number as well?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] And do you have a reference number for today?
[AGENT][NEUTRAL] That's just my name, [PII]. First initial to last name is [PII], and today's date.
[CUSTOMER][POSITIVE] All right, I appreciate it. Thank you so much and have a great day.
[AGENT][POSITIVE] OK, thank you for calling APLU as well. Bye-bye.
[CUSTOMER][NEUTRAL] Yes ma'am, bye now.