AccountId: 011433970860
ContactId: 5d87a5ab-2173-40cb-b898-532910cf2ae6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436940 ms
Total Talk Time (AGENT): 167452 ms
Total Talk Time (CUSTOMER): 248914 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/5d87a5ab-2173-40cb-b898-532910cf2ae6_20250305T21:33_UTC.wav
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[AGENT][NEUTRAL] Contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, how's it going? I'm calling from a doctor's doctor's office. My name is [PII]. We have a patient, um, that has an APL gap insurance, and we have never billed to a gap insurance before, so we have no idea how to actually get paid for this gap insurance. The patient claims that you guys cover all copays and deductibles, um, but we just don't know how to do it.
[AGENT][NEUTRAL] OK. Yes, I can certainly look that up. And [PII], what is the uh policy number, please?
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I'm seeing uh in hospital benefits cert number and an outpatient benefits cert number, is that what you want, or is it something else?
[AGENT][NEUTRAL] You might
[AGENT][NEUTRAL] Yes, either one of those would work, yeah. Either one of those 2 numbers.
[CUSTOMER][NEUTRAL] OK, I'll give you the outpatient 1, 02598.
[CUSTOMER][NEUTRAL] 409.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And his birthday is [PII].
[AGENT][POSITIVE] I appreciate that. I just need a callback number please, while I'm looking that up.
[CUSTOMER][NEUTRAL] For us?
[AGENT][NEUTRAL] Uh yes, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Now,
[CUSTOMER][NEUTRAL] This is Doctor [PII]'s office.
[AGENT][NEUTRAL] That, OK, thank you. Um, this is a secondary or gap insurance. Uh, it's meant to pick up the deductible, co-payment or co-insurance from [PII]'s Major Medical. Now, what we cover under this policy is in and out of hospital settings as well as treatment within the physician's office. And normally what you'll do in a situation like this is that you will file through his major medical first, and then you will receive an explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That shows the the the deductible.
[CUSTOMER][NEUTRAL] We've already received received that.
[AGENT][NEUTRAL] Oh, good. OK. In that case, um, you would just um uh submit a HICA form along with that EOB.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] Then we would just we would go ahead and pay, uh, pay you for the, for the services. Now for outpatient services, we will pay up to $1250 per calendar year for inpatient, it's $2500. It's just a verification, not a guarantee of payment. But I'll tell you that the office visit isn't covered. It's just treatment within the physician's office that's covered.
[CUSTOMER][NEUTRAL] The sorry, what, what, what do you like um.
[AGENT][NEUTRAL] The office,
[CUSTOMER][NEUTRAL] So we, so we came in for.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see what you keep it for.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] You have 2 visits that we've see I mean we saw them today but we haven't received any um.
[CUSTOMER][NEUTRAL] Uh, and, and you'll be get from, from that visit, but for the past two visits we've already received everything. The first one was a prostate biopsy.
[AGENT][NEUTRAL] Oh, of course.
[CUSTOMER][NEUTRAL] Um, and it was a $45 co-pay for that prostate biopsy, and then we saw him again for a follow up, and that was just a regular office visit with a co-pay of $45 and then we saw him again today for another follow up which was a co-pay of $45.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] So in total it's $135 of copays. So is that something you guys cover or is it just like in office procedures? I think the biopsy might.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Uh, fit that description. I don't know if the office.
[AGENT][NEUTRAL] Yes, yes, it would. The office visits would not. Uh, so the biopsy would, uh, you can certainly submit that to us, um, but the office visit co-pays uh are not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so if I have the.
[CUSTOMER][NEUTRAL] Um, the what's it called, the.
[CUSTOMER][NEUTRAL] The EOB for that one visit that was the the prostate biopsy um how do what what do I have to do to get?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] The $45 co-pay.
[AGENT][NEUTRAL] Absolutely. So what you need to do is um you would uh create a, a, or you would uh send us a 1500 the HEIFA claim form along with a copy of that uh EOB showing the deductible co-payment or co-insurance that's owed for the biopsy. And what we would do at that point is, uh, we would, uh, when we process it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We would then send the benefit to you.
[AGENT][NEUTRAL] But you would just send them a claim form and and then that EOB and that's that's the uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What do I get that clay for?
[AGENT][NEUTRAL] Uh, when you can actually get that online, let me see if I can't, um, I think we even have one,
[CUSTOMER][NEUTRAL] We, we, we do everything like electronically through our our system so this is like very you know like not normal for what we do um to like submit or like uh a form to a gap insurance.
[AGENT][POSITIVE] Oh, OK, well perfect.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] If I give you my electronic filing um number, would that be helpful?
[CUSTOMER][NEUTRAL] Is that like a claim claim ID?
[AGENT][NEUTRAL] Uh, no, it's our electronic, yes, the payer ID for electronic filing. Would that be helpful?
[CUSTOMER][NEUTRAL] Or I mean a a payer ID.
[CUSTOMER][NEUTRAL] OK, yeah, if you have a payer ID we can just.
[CUSTOMER][NEUTRAL] Submitted
[CUSTOMER][NEUTRAL] That way that would be much easier for us so it's a it's almost like a like a regular insurance right?
[AGENT][NEUTRAL] Sure, it's 60.
[AGENT][NEUTRAL] Uh yes, uh-huh, yeah, it's just that it's just that we're secondary and so um.
[CUSTOMER][NEUTRAL] Yeah, so what's the payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801 and then it's just called American Public Life.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] American public.
[CUSTOMER][NEUTRAL] Life.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let me just make sure let me go to this place where we add new.
[CUSTOMER][NEUTRAL] Because it always ask me every time I look at the PRID it always kind of asks me for some other information as well um.
[CUSTOMER][NEUTRAL] Give me 1 2nd, let me just see if I can answer that.
[AGENT][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Um, yeah, I mean, I put it like the name, the address, telephone, fax, and then it says gives me an option for the payer ID, and then it says like meta gap ID, ERA payer ID, manage care plan ID, eligibility payer ID. I'm not sure if those are.
[CUSTOMER][NEUTRAL] Or maybe I maybe I just need the payer ID for that one and then we have a source of payment.
[AGENT][NEUTRAL] Well, it's
[CUSTOMER][NEUTRAL] And it's like
[CUSTOMER][NEUTRAL] It would it be commercial insurance company?
[AGENT][POSITIVE] Yes, that's exactly what we are.
[CUSTOMER][NEUTRAL] So code CI.
[AGENT][NEUTRAL] Yes, we are commercial insurance.
[CUSTOMER][NEUTRAL] I don't know if that's OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Insurance type would be commercial.
[CUSTOMER][NEUTRAL] OK, I'm gonna see if I can put this together, uh, and we'll try to submit it, but we should only submit for procedures office visits will not get covered, you're saying?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, sounds good I will let the patient know.
[AGENT][NEUTRAL] Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] No, I'm gonna give this to the biller and see what she can do.
[AGENT][NEUTRAL] OK. OK. Well, there's anything else that you, you need any help with anything, just let us know.
[CUSTOMER][POSITIVE] All right thank you very much.
[AGENT][POSITIVE] Thanks for contacting AP