AccountId: 011433970860
ContactId: 5ca63f22-a867-42ca-baa2-4562b2a5447f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334109 ms
Total Talk Time (AGENT): 157635 ms
Total Talk Time (CUSTOMER): 99972 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/5ca63f22-a867-42ca-baa2-4562b2a5447f_20250415T18:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to confirm a patient's benefits.
[AGENT][NEUTRAL] OK, [PII], you're needing just benefit information or do you also need eligibility?
[CUSTOMER][NEUTRAL] Um, eligibility as well, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, I have the, I mean, there's a group number on the card. I don't have a policy number.
[AGENT][NEUTRAL] OK, there should be another, some form of number on the um.
[CUSTOMER][NEUTRAL] That was
[AGENT][NEUTRAL] On the ID card, it may say in hospital or outpatient or
[CUSTOMER][NEUTRAL] Oh, I see. OK. Outpatient. OK. Um, yeah, I have a uh 02144659 ML 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, place, and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Did you
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, he, he is scheduled for an out for two outpatient surgeries at our ambulatory surgery center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, his outpatient benefit maximum per calendar year for covered outpatient services is $8700 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEGATIVE] And as of now, he has not used any of his benefits for this calendar. There have not been any benefits used for this calendar year as of now.
[CUSTOMER][NEUTRAL] OK. And then, um, it being a benefit max for the year, would there be a percentage that it covers?
[AGENT][NEUTRAL] Up to the 700 is the maximum benefit again for covered outpatient services this policy helps him with his co-pays, deductibles and co-insurance amounts of coverage services. So when the claim is submitted to APL [PII] for review, we will also have to have a copy of his primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we've processed the claim here at APL we do have a portal that you should be able to check our claim status in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And the website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so if the patient pays their for the procedure, the deductible part that he's responsible for from the primary insurance and then we bill the EOB to you, would the patient be uh reimbursed?
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] We typically the benefits would be paid to whomever files the claim.
[AGENT][NEUTRAL] Unless there is some type of different assignment of benefits on the claim, it would be whomever files it.
[CUSTOMER][NEUTRAL] OK, what I'm just saying is that usually when a patient has a large deductible with their primary insurance, we would collect the patient responsibility up front, bill the insurance, and then if the insurance covers that part for the patient, we reimburse the patient. So I was just asking how that would work. Would it be that you reimburse the patient or we would we would then reimburse the patient after you pay us?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In that scenario, it would be your, if we issued the payment to you, then yes, you would.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, um, and is there uh an authorization that would be required with this plan?
[AGENT][NEUTRAL] Not with the supplemental, no, ma'am.
[CUSTOMER][NEUTRAL] OK, um, and is there a reference number for the call?
[AGENT][POSITIVE] Yes, ma'am, you would actually use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right, thank you so much for your help today.
[AGENT][POSITIVE] Well, you're certainly very welcome, [PII]. So again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that was everything.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a nice afternoon also.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.