AccountId: 011433970860
ContactId: 5d81613b-48f0-41e8-981a-18e66995bc0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243800 ms
Total Talk Time (AGENT): 102416 ms
Total Talk Time (CUSTOMER): 117755 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/5d81613b-48f0-41e8-981a-18e66995bc0b_20250127T19:11_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, [PII], I, I'm calling because I wanted to verify coverage for a patient.
[AGENT][POSITIVE] OK, I can help you with the benefits. And may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Sure. Uh my first name is [PII], last name [PII], and the best contact number for um for us is [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Alrighty, um, the outpatient policy number, it is 024.
[CUSTOMER][NEUTRAL] 628-71 M as in Mary, L as in love, 8.
[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] First name [PII], last name [PII], and date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, well, I wanted to, uh, because he came to an urgent Care Express site. I wanted to see if he has, um, I do see that he has a co-pay of $75. Would that be waived, uh, based on APL?
[AGENT][NEUTRAL] Waived, Hold on one moment, let me pull up the benefits. But no, so where it's not waived. So as his second, you'll bill primary first and then us. If he has to pay the copay, then he could be reimbursed on the back end once we process the claim, but it's not waived.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's not a gap insurance.
[CUSTOMER][NEUTRAL] this policy.
[AGENT][NEUTRAL] It is a gap insurance, but we work on the back end because the services aren't completed.
[CUSTOMER][NEUTRAL] On the back end.
[CUSTOMER][NEUTRAL] OK. Alrighty. And can you provide me a reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um again, that's [PII], the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and, and can you repeat uh the effective date of the, of the policy?
[AGENT][NEUTRAL] Oh, sure, hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, perfect. Thank you so much. I appreciate that, [PII]. You have a wonderful rest of the day. So just to summarize this, her, his um primary insurance is United. I put you guys as a secondary, they and then you guys, um, they send you the, the bill and if he has any responsibility, then he, he'll be responsible for that.
[AGENT][NEUTRAL] Who sends us, no, you all will bill us after you bill primary.
[CUSTOMER][NEUTRAL] OK, so Bill United, then bill you guys and, and, and if you guys have uh any coverage additional that he needs to pay, he'll be responsible for that.
[AGENT][NEUTRAL] Right, our policy goes to the co-pay, deductible and co-insurance of coverage charges after primary.
[CUSTOMER][POSITIVE] OK, perfect. Copay.
[AGENT][NEUTRAL] We don't determine, you're good?
[CUSTOMER][NEUTRAL] Yeah, yeah, that's what I was asking because he has a co-pay for urgent care of $75. That's what I was asking if if you guys, uh, because some gap insurance do um pay the copay instead of the patient.
[AGENT][NEUTRAL] Right, so if you, if your facility makes him pay upfront, he's gonna have to pay because we're not gonna know anything until the claim is filed, which is after the services. So it depends on what your facility does.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, so if we, if we charge you $75 and then um we bill you guys, but you guys, that policy covers the $75 you guys reimburse the patient?
[AGENT][NEUTRAL] Correct. We could reimburse the patient or we could pay it to you if there's an outstanding balance.
[CUSTOMER][POSITIVE] OK, gotcha. Thank you so much for all that information. I'm just noting that, just want to make sure. All righty, Ms. [PII], thank you so much and you have a wonderful rest of the day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Bye bye.