AccountId: 011433970860
ContactId: 5658bd01-e6c3-4402-812e-9446fc579ae1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205259 ms
Total Talk Time (AGENT): 88517 ms
Total Talk Time (CUSTOMER): 90671 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/5658bd01-e6c3-4402-812e-9446fc579ae1_20250619T21:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from an urgent care and I have one of your patients checking in for an urgent care visit.
[CUSTOMER][NEUTRAL] And I'm just calling to verify or see.
[CUSTOMER][NEGATIVE] Uh, what's covered? I don't, I'm bill, we're gonna bill this as a supplement you guys as a supplement, so I don't know if I need to take the patient's normal co-pay or what does that make sense?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, let me see um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What their policy covers, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It, I don't see a policy number. I see a group number. I see a payer ID number.
[AGENT][NEUTRAL] Any policy certificate number or benefit number that starts with maybe a 01 or 02?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, do you have their
[CUSTOMER][NEUTRAL] OK, here, yeah, no I do I see it. OK, there is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And outpatient here we go, outpatient is 02553717.
[CUSTOMER][NEUTRAL] M as in Mary, L 8.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII] born [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Yeah you bet.
[AGENT][NEUTRAL] All right, this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up the policy.
[AGENT][NEUTRAL] So this is secondary gap insurance. So, uh, the primary will need to pay benefits first. This does help pay towards co-pay, co-deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see for outpatient you said outpatient services correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and this is just a verification of benefits, not a guarantee of payment. It looks like they have an outpatient benefit maximum of up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a $0 outpatient deductible per calendar year. And it does, uh, it does cover urgent care facilities.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK great all right thank you so much and does it, do we just normally bill it and see what's paid?
[AGENT][NEUTRAL] Um, you'll you'll bill with the primary first and then.
[CUSTOMER][NEUTRAL] Or is there a specific amount?
[AGENT][NEUTRAL] Uh, no, you'll go with the primary first and then, um, when filing a claim with us, you'll need to send us a copy of the EOB from the primary, um, to see what all is left and then we could pay up to that amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I see, I see, OK, thank you so much.
[AGENT][POSITIVE] Great. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No ma'am, thanks a lot I appreciate it.
[AGENT][POSITIVE] Great. Thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][NEUTRAL] Bye.