AccountId: 011433970860
ContactId: 40f3f906-54f1-42f7-83d5-9ceaf1de8855
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387350 ms
Total Talk Time (AGENT): 198670 ms
Total Talk Time (CUSTOMER): 141468 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/40f3f906-54f1-42f7-83d5-9ceaf1de8855_20250204T14:19_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, [PII]. Good morning, [PII]. My name is [PII]. Last initial is [PII], and [PII], what's the initial for your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh OK. I was calling, I'm calling from Saint James Parish Hospital and I was calling to verify the benefits for this patient.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the benefits and when you said your name and email came through and I didn't hear you at all, can you repeat your name for me, please? I'm sorry.
[CUSTOMER][NEUTRAL] It's [PII], the last initial is [PII]
[AGENT][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] All right, and [PII], may I have a good contact number in case we're disconnected and I'll be more than happy to help with the benefits.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Members's policy number is 2180312.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] OK, the patient is coming in for a CT scan, CPT code 741777.
[CUSTOMER][NEUTRAL] Uh hospital outpatient and I was calling to get the benefits for that particular cold.
[AGENT][NEUTRAL] OK, so we don't really go by codes, we're more so a place of service. So for outpatient, the calendar year max is $5000.
[AGENT][NEUTRAL] Oh, hold on one moment. Actually, it's $6000 it went up $1000 this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that does include um diagnostic testing in an outpatient um facility or MRI facility.
[AGENT][NEUTRAL] Did you want me to see if any of that 6000 has been used for the year?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And none of the um benefits have been used for this year yet, so he still has that full 6000 for the year.
[CUSTOMER][NEUTRAL] OK, what's the coinsurance?
[AGENT][NEUTRAL] And we don't apply this, hold on, let me double check.
[AGENT][NEUTRAL] Yeah, so this is their secondary policy, so we apply towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] Oh, it's the primary, OK, so it just has a $6000 deductible.
[AGENT][NEUTRAL] Um, it's not a deductible. Their primary insurance and then their secondary insurance, our insurance, we have our own benefits. So,
[AGENT][NEUTRAL] Basically, if primary applies or charges a deductible, he has up to $6000 that we can use to help with those charges, the co-pays, the deductibles.
[AGENT][NEUTRAL] Coinsurance. It's kind of like a gap policy.
[CUSTOMER][NEUTRAL] So your insurance pays for his deductible for the primary.
[AGENT][NEUTRAL] Right, we're second to primary. So they still, if they, if you're required to pay it to have the services, they will still have to pay that. But on the back end, when you file the claim with us, we'll have the primary explanation of benefits to see what was charged, what they paid, they can be reimbursed or if there's something still owed to you, we can pay you as a provider, but we're second, we don't apply charges, we help pay it.
[CUSTOMER][NEUTRAL] Oh, OK, so you help pay the charges. So once we submit the claim to the primary insurance, so my, my thing is, OK, so does this patient have to pay for this? OK, so the patient either pay the patient pays for it out of pocket first and then you reimburse the patient.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, if it's a covered charge, yes, they could be reimbursed. They just have that 6000 for the year. So you bill primary first, primary will apply based on their policy benefits, and then you bill us automatically second. And then when you bill us, you'll send the explanation of benefits, your bill, and we'll be able to see what was charged, what was paid.
[CUSTOMER][NEUTRAL] What was charged and what and what you and what you're gonna pay the patient back.
[AGENT][NEUTRAL] Mhm, or old to you if something is still old after primary.
[CUSTOMER][NEUTRAL] Oh OK, alright.
[CUSTOMER][NEUTRAL] OK, so um no authorization or anything through you guys or anything?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. No authorization required. No, ma'am.
[CUSTOMER][NEUTRAL] No priests are needed, right.
[CUSTOMER][NEUTRAL] Alright, so this policy will pay back, we'll pay what the primary does not basically pays what the primary doesn't cover, right?
[AGENT][NEUTRAL] I don't want to say it like that now, because our policy has its own benefits too, but
[CUSTOMER][NEGATIVE] Oh, no, no.
[CUSTOMER][NEUTRAL] Policy was basically was this primary, this policy is gonna pay back uh well I don't wanna say like they need to.
[AGENT][NEUTRAL] We pay, we pay towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Pay towards copay, deductible, co-insurance, after like, just like that, after the primary.
[AGENT][NEUTRAL] Mhm. You should put up covered charges after primary.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Of covered charges.
[AGENT][NEUTRAL] Mhm, because our policy has its own benefits too, so sometimes it's covered under the primary, but it's not covered with secondary because it's not a benefit on their policy with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy will be towards co-pay, deductible co-insurance after the primary of co-insurance of the cover charges after the primary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Let me get a reference number, [PII].
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] All right. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.