AccountId: 011433970860
ContactId: 43a22073-e9f6-4f0c-90f0-a06831defa2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631820 ms
Total Talk Time (AGENT): 217823 ms
Total Talk Time (CUSTOMER): 203622 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/43a22073-e9f6-4f0c-90f0-a06831defa2b_20250217T16:47_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], um, can I get the initial to your last name, please?
[AGENT][POSITIVE] Yeah, absolutely. It's [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. My name is [PII], initial [PII].
[CUSTOMER][NEUTRAL] And I'm calling on behalf of Doctor [PII], um, just to get some info, um, regarding this plan. Um, it was provided to us by one of our pregnant patients.
[AGENT][NEUTRAL] OK. Let's take a look, [PII]. Do we have their policy number?
[CUSTOMER][NEUTRAL] Um, I'm not sure if this is the policy number. She is very short. This is what she gave us, and that would be 60801.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, that's actually [PII], our payer ID so.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's OK. We can, we, we can check by name or if you have social we can also use that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if she gave a social. Um, I had a feeling that was not it. Um,
[AGENT][NEUTRAL] No, right.
[CUSTOMER][NEUTRAL] All right, so I can give you the social, let me know when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I've got [PII].
[AGENT][NEUTRAL] Great, and then it started with [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. Cursor was kind of in the wrong area, but I thought that's what I heard here. One second.
[CUSTOMER][POSITIVE] Yeah, alrighty.
[AGENT][NEUTRAL] They
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK. And then what is the patient's first and last name?
[CUSTOMER][NEUTRAL] Her name is [PII], and, oh yeah, that's it.
[AGENT][NEUTRAL] OK, and then date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, perfect. Thank you for that.
[AGENT][POSITIVE] OK, so did you need the policy number? I'm happy to provide that.
[CUSTOMER][POSITIVE] Yes please thank you.
[AGENT][NEUTRAL] OK, no problem. So policy number is going to be 02464681.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the effective date for the patient on this plan is [PII].
[AGENT][NEUTRAL] This is a secondary plan, a gap plan, so it covers deductible, co-pay, co-insurance that the primary does not, um, are we looking for like outpatient benefits or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, OK, so this is a gap plan. Patient tried to tell us that this is her primary policy, but I, I have this plan, so I know it's a gap plan. Um, OK, so gap plan. So first of all, we know that, um, not a primary. OK. And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So she is pregnant. So you had mentioned it covers um
[CUSTOMER][NEUTRAL] Deductible
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And is it, does it pick up coinsurances also?
[AGENT][NEUTRAL] Yeah, and co-pay, and it looks like she has a maternity writer on here. Sorry, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh no, if you could just go ahead with that, that'd be great.
[AGENT][NEUTRAL] Yeah let's see what it says here.
[AGENT][NEUTRAL] uh.
[AGENT][NEUTRAL] I'm sorry, I'm just trying to get to it. I'm scrolling through all this stuff just a second.
[CUSTOMER][POSITIVE] Oh yeah, no problem at all.
[AGENT][NEUTRAL] Gosh, it doesn't really say a whole lot.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um, so is she just being, is she being seen by you guys basically for pregnancy care, is that correct?
[CUSTOMER][NEUTRAL] Right. For the prenatal, uh, postpartum, and then the physician delivery.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] And a child maternity Amendment right.
[AGENT][NEUTRAL] I don't see any sort of
[AGENT][NEUTRAL] Like exclusions or anything like that where it wouldn't be covered. It has an in-hospital benefit maximum of $5000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In hospital, um, this plan is considered, she would need to be inpatient for at least 18 hours or longer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so in hospitals maximum benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is 5000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] And then the out
[CUSTOMER][NEUTRAL] Is there a max benefit? Go ahead, I'm sorry.
[AGENT][NEUTRAL] Go ahead, no, I was just gonna say the outpatient benefit max on the plan is actually a calendar day, not a year, um, and that's 500 a day.
[CUSTOMER][NEUTRAL] OK. And does it specify for physician, um, if there's a max benefit for physician or for maternity?
[AGENT][NEUTRAL] No, it would just be whether or not it fell under an outpatient uh service or an inpatient service.
[CUSTOMER][NEUTRAL] OK, so outpatient max.
[CUSTOMER][NEUTRAL] is 500, so.
[CUSTOMER][NEUTRAL] If we're billing with this particular plan, um, she's had other insurance, so we're not gonna bill global. So we bill out the prenatal and postpartum visits, um, that would have a max of $500 per day.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] About 500, which
[CUSTOMER][NEUTRAL] Gonna exceed that. OK. So in hospital max benefit is 5000 outpatient, um, max of 500 per day.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] This is definitely a gap plan. Um, so we would bill her primary insurance first. Um, the patient file her own?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, claims through the gap, usually that's how we do it.
[AGENT][NEUTRAL] It's honestly it's I found it's provider preference um we have providers do that do file the claims on behalf of the insured um or they can do it either way.
[CUSTOMER][NEUTRAL] OK. Patient can file her own claim. Perfect. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then of course, that's with the um the EOBs once processed through her primary insurance. OK.
[AGENT][POSITIVE] Yeah, exactly, yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Thank, oh, you know what, can I get the claims mailing address just in case and obviously I have the, the payer ID and she gave that to me.
[AGENT][NEUTRAL] Yeah, absolutely. Claims mailing address is going to be um [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] OK perfect and can I get a reference for the call?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with my last initial, then today's date. So my name again is [PII], that's [PII] and then just today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your time. You have a great day.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] All right, bye.