AccountId: 011433970860
ContactId: 42231149-14c2-42c8-90db-56eeb013836b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286500 ms
Total Talk Time (AGENT): 118027 ms
Total Talk Time (CUSTOMER): 91132 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/42231149-14c2-42c8-90db-56eeb013836b_20250530T19:01_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]. This is [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] And I'm calling from Tanova North Knoxville Medical Center.
[CUSTOMER][NEUTRAL] The patient's given us this as a medical coverage, but he's not sure if it will cover for his procedure as secondary. So I'm calling to verify his benefits.
[AGENT][NEUTRAL] OK. Let's take a look. What is the patient's policy number?
[CUSTOMER][NEUTRAL] 1381794
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh name and date of birth.
[CUSTOMER][NEUTRAL] It's gonna be for [PII] 914-74.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. Patient is active. Uh, the effective date on here is [PII].
[AGENT][NEUTRAL] And it is a secondary plan, so it does pick up deductible, co-pay, co-insurance from the primary.
[AGENT][NEUTRAL] The outpatient benefits, let's see.
[AGENT][NEUTRAL] OK. So under their outpatient uh benefits, it does list outpatient surgery in a hospital or freestanding surgery center.
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] It's a benefit of 750 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, is this like a limited medical plan?
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] Um, I mean, it has that amount. It's not a limited benefit plan. It's a stand like secondary plan, gap plan.
[CUSTOMER][NEUTRAL] OK, and is this something that we would send the claims to y'all on?
[AGENT][NEUTRAL] Mhm, so you could build primary and then once that's been billed build us a secondary we just need um the EOB from the primary on that.
[CUSTOMER][NEUTRAL] OK, let me look at something here let me see what his.
[CUSTOMER][NEUTRAL] Estimated.
[CUSTOMER][NEUTRAL] Amount due is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's a 250 copay through his primary.
[CUSTOMER][NEUTRAL] So how would that work? That would be if y'all pick up copays, deductible and co-insurance.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So once you build
[CUSTOMER][NEUTRAL] Then we would not charge him.
[AGENT][NEUTRAL] Right, so then we would send you the 250 since his outpatient benefit max is 750 for the calendar year.
[CUSTOMER][NEUTRAL] And he has not used anything?
[AGENT][NEUTRAL] No, he has not.
[CUSTOMER][NEUTRAL] OK. And do you need a CPT or anything to make sure that it's something y'all would cover?
[AGENT][NEGATIVE] Um, no, that's not necessary at all.
[CUSTOMER][NEUTRAL] OK, and we'll be sending the claims to uh APL Gap Insurance, is that correct?
[AGENT][NEUTRAL] You can just address it to APL attention claims.
[CUSTOMER][NEUTRAL] OK, and what is the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] I can also give you the payer ID and fax if you would like.
[CUSTOMER][NEUTRAL] OK, the payer ID please.
[AGENT][NEUTRAL] It's gonna be 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And a reference number for the call please.
[AGENT][NEUTRAL] Call references my name with today's date. My name again is [PII], which is [PII] My last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. All right, I got it. Thank you so much. I appreciate it.
[AGENT][POSITIVE] Yeah. You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.