AccountId: 011433970860
ContactId: 36107622-5f4a-4f0f-a696-8ea7742188e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200119 ms
Total Talk Time (AGENT): 90871 ms
Total Talk Time (CUSTOMER): 74693 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/36107622-5f4a-4f0f-a696-8ea7742188e4_20250226T17:15_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Sorry about that. Good morning. My name is [PII]. um, last name [PII] I am calling to verify a patient's benefits please.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh yes, policy number is going to be 02565831.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, I'm sorry, [PII], last [PII]
[CUSTOMER][NEUTRAL] And what was your name again?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome and verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] Uh, yes, it's gonna be [PII] and [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. I've shown her effective date is [PII]. She is active on the policy and what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] Um, so this patient has a primary insurance as United Health Care Managed Care. I just wanted to see if this, um, secondary gap insurance covers the patient's co-payment or deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, patients having a procedure tomorrow.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and is this going to be an inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's outpatient.
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment, just a verification of coverage, uh, showing the patient has, well, with this policy is secondary, it does help with primary insurance deductible, co-pay and or co-insurance, and she has an outpatient benefit max up to $8500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and so basically what we'll do is just bill um.
[CUSTOMER][NEUTRAL] The sec let the primary insurance um run its claim and then let it bill to the secondary, correct, which is this one?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, essentially, but most primaries don't submit claims to us. It will be up to the provider to submit the itemized bill and the primary EOB so we can process the secondary.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Either so it's up to the ordering provider's office.
[AGENT][NEUTRAL] Yes, sir. So once the primary is processed the claim, they would just need to submit the billing and the primary EOB so we can process the secondary.
[CUSTOMER][NEUTRAL] I need to submit the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So would you recommend it for us to just go ahead and charge the patient and patient gets reimbursed or just submit the EOB after the claim runs?
[AGENT][NEUTRAL] Uh, just submit the EOB.
[CUSTOMER][POSITIVE] OK perfect we'll go ahead and do that um that's exactly what we needed um OK perfect um do you have a reference number for today's call?
[AGENT][NEUTRAL] Uh, no, sir, but if you like, you may use my name at stay State, and [PII], is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] Bye.