AccountId: 011433970860
ContactId: 499c6da0-e554-45e4-8624-c6c7a2287051
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 171220 ms
Total Talk Time (AGENT): 92313 ms
Total Talk Time (CUSTOMER): 59156 ms
Interruptions: 1
Overall Sentiment: AGENT=2.6, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/499c6da0-e554-45e4-8624-c6c7a2287051_20250403T21:03_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I am a provider and I had a uh question.
[CUSTOMER][NEUTRAL] So one of our clients has APL, but for her primary she has high mark so do we just submit it to Highmark and then to APL is secondary?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it depends. Let me look and see what type of um policy they have with us, and, um, but I'll be more than happy to look into it for you. And [PII], may I have a, you're welcome. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, so it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02579240
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth [PII] [PII].
[AGENT][NEUTRAL] Thank you. And all the information provided is a verification of benefits, not a guarantee of payment. Um, hold on one moment, let's look and see if
[AGENT][NEUTRAL] What type of policy they have? Hold on one second.
[CUSTOMER][POSITIVE] Oh, no problem.
[AGENT][NEUTRAL] So, so we are the secondary insurance, but this policy is second only to Florida Blue.
[CUSTOMER][NEUTRAL] OK, yep, so Florida Blue, so we'll submit it to Florida Blue and then they tell us the deductible and then you guys will pay the secondary like whatever they tell you.
[AGENT][NEUTRAL] So you'll bill um Florida Blue, they'll apply based on their policy. Um, when, when the cus when the patient is there, if there's a co-pay or deductible that's required upfront for the service, they'll pay that. On the back end, once we receive it a second, um, we'll get the you'll send over the explanation of benefits and the bill, then we'll be able to see what's owed to the patient and what's still owed to you, and then there is a, let me see how this policy is broken down.
[AGENT][NEUTRAL] There's a calendar year max, so like for outpatient, that max is $5000 per person per calendar year, so we would pay out up to that amount per calendar year.
[CUSTOMER][POSITIVE] Oh perfect because that's what her deductible is, is 5000 and then after that it's covered at 100 with high mark. So OK, that makes sense. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, and then the payer ID is 60801, is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK awesome thank you so much I really appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too, bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.