AccountId: 011433970860
ContactId: 60f09fd4-3352-4b7a-b850-b40336afadb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625309 ms
Total Talk Time (AGENT): 194852 ms
Total Talk Time (CUSTOMER): 404517 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/60f09fd4-3352-4b7a-b850-b40336afadb4_20250213T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. My husband is a subscriber through his employer, and we have APL as I, I guess it's uh supplemental insurance, and I have Cleveland Clinic billing on the phone. Um, I was, I have, um, I was wanting to try to get the card verified because I was not able to upload it in the system and so they're on the line right now if you can.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you happen to have that policy number, Ms. [PII], or no?
[CUSTOMER][NEUTRAL] I do. It's, um, I have the card in front of me. It's OK, payer ID is 60 I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. Do you see a policy certificate um in hospital outpatient benefit certificate number should be at the bottom. Mhm.
[CUSTOMER][NEUTRAL] Oh yes, OK, yeah, OK, so in hospital benefit certificate number is 01931051M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] It's [PII] and mailing address is [PII].
[AGENT][NEUTRAL] OK, thank you so much. And you said the providers on the line right now, they're wanting to verify benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, we just want to make sure it's active and get some information to put in our system to bill you guys out for claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK, I can verify that for you. And ma'am, your name is?
[CUSTOMER][NEUTRAL] My name is [PII]. What is yours?
[AGENT][NEUTRAL] [PII], last initial [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. I'm showing an effective date [PII], policy is active. And what benefit information are you needing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on [PII].
[CUSTOMER][NEUTRAL] And you're the secondary insurance, correct?
[AGENT][NEUTRAL] We are, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, is there a group number that's attached with the policy number or no? I have it.
[AGENT][NEUTRAL] Uh, group number 23, I'm sorry, 24351.
[CUSTOMER][NEUTRAL] 243-51.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I need the the mailing address.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, repeat it a little bit slower for me. I have [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the zip one more time?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, do you guys have a fax?
[AGENT][NEUTRAL] Yes, ma'am. Uh, fax number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I forgot. Give me a 2nd. [PII].
[CUSTOMER][NEUTRAL] OK. And.
[CUSTOMER][NEUTRAL] I think that's it and we bill as outpatient provider based billing so it's gonna be as outpatient so does she still have coverage for outpatient services?
[AGENT][NEUTRAL] Yes, outpatient is covered. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and I have the number in the outpatient benefit certification number, uh [PII] if you wanna write this is 01931051ML8 it ends in an 8. So which ones do we need to use because we bill as an outpatient hospital stay and the only time we will bill as inpatient is if she's inpatient so we can't change the.
[CUSTOMER][NEUTRAL] ID number every time it's switching it so which one so so which.
[AGENT][NEUTRAL] Well, it's the same number except for ML 7 or 8, so just the 1931051 is fine.
[CUSTOMER][NEUTRAL] OK, OK, so, so I can put 01931051?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I just wanna make sure cause I know it will get confusing when you do inpatient and observation and stuff like that. I just wanna make sure. OK. OK. And I need a call reference from you.
[AGENT][NEUTRAL] No, I'm saying.
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. Uh, you may use my name in today's date if you like.
[CUSTOMER][NEUTRAL] And today's date is [PII].
[CUSTOMER][NEUTRAL] 5. OK.
[CUSTOMER][NEUTRAL] OK, and you said she's active starting [PII], correct?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much for helping us out getting this information.
[AGENT][POSITIVE] Alright, you're welcome. And is there
[CUSTOMER][NEUTRAL] So, um, [PII], let me ask you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, real quick, I just wanna double check because uh it's, it's, I, I've done this before with you guys like back in [PII] because secondary insurance is so tricky, you know, and so I just wanna make sure so this is, this is pretty much um because my husband assumed that it's like gonna pay for everything and I'm like, no, you know, so tell me, just give me a brief, a brief, it's like for when you're like it says here like if there was an outpatient benefit, you know, after they build the primary then, then they may be able to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The bill APL for.
[CUSTOMER][NEUTRAL] Additional services or copays after that?
[AGENT][NEUTRAL] Uh, the way the policy works is so after primary insurance is processed the claim, uh, if they apply any amounts towards deductible, co-pay or co-insurance, that's what we pick up and pay up to the max benefit of $3000 per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, deductible copay.
[CUSTOMER][NEUTRAL] And what was the other one, coinsurance, OK, so it pays um.
[AGENT][NEUTRAL] Co-insurance.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Towards the deductible up to 3K. OK, OK, 3K is the max. OK, I'm just writing it down just so I stop bothering you guys with this trying to figure out. OK, alright, so, uh, is that [PII], is that all you need for you for, for you? No, no, what I was asking, are you considered an actual insurance company or a gap insurance?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No you're fine.
[AGENT][NEUTRAL] No, we're an actual insurance company.
[CUSTOMER][NEUTRAL] OK. The the reason why I was asking those those questions is because if you're like a gap insurance, then the patient will be submitting the claims versus us submitting cause we're gonna keep submitting the claims no matter what. If she's hit her, cause we're hit her deductible amount that you're gonna pay and hit her max that you're gonna pay, we're gonna keep sending the claims. Is that still OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. We do take assignments. So if a provider submits the claim information needed and benefits are assigned, we do pay the provider.
[CUSTOMER][NEUTRAL] OK, no, no, what I'm saying is if she hit her back out of pocket deductible that the the limit amount you just said is 3000 if she hits that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And she has another data service and she's already hit it you're not gonna pay those extra claims.
[AGENT][NEUTRAL] Correct, cause she had met her Max.
[CUSTOMER][NEUTRAL] But we're still gonna be filling you out for those claims.
[CUSTOMER][NEUTRAL] OK, because we'll still be sending the claims, so that's why I was asking those questions. OK, I see, yeah.
[AGENT][NEUTRAL] Oh, I understand. So if once they've met their benefit max, then there's nothing for us to pick up and pay since they've met the max for the year.
[CUSTOMER][NEUTRAL] So you guys would, yeah.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm thinking maybe you could put a note in the file max 3K so you guys don't have to do no we can't do that. No, it's automatically when it submit the system automatically bills out they would have to physically deny the claim saying no funds available. So that's why I was asking if you guys were in actual.
[CUSTOMER][NEUTRAL] Insurance company or an actual third party um gap insurance. So that's why I was asking those questions because I know with certain gap insurances, the patient has to send it and then once you hit your max, they don't, you wouldn't get the information to them. But if you're wanting us to bill it out and keep billing out for all the states of services, even though she's gonna hit her max, she's still gonna owe it.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] How would you guys deny those claims?
[AGENT][NEUTRAL] If a claim comes in and it already met their max their benefit, it would just be processed as the outpatient benefit is maxed for the calendar year, so it will be denied as benefits of max.
[CUSTOMER][NEUTRAL] Thing that covered.
[CUSTOMER][NEUTRAL] OK, and then we would bill out the patient for the reminding. OK, that's why I was just wondering because what, what I'm asking is for my guidelines to put in my notes.
[AGENT][NEUTRAL] No, I understand. Yes, ma'am.
[CUSTOMER][NEUTRAL] But the thing is the other department that the other department that builds it out, they're not gonna see any of that they're gonna just basically keep billing you guys out doesn't matter if we because we don't even have the benefits or anything like that we just verify so that's why I that's in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, ma'am, I understand. But no, uh, we'll send out if benefits of max, then we will process as the outpatient benefit is max for the calendar year and an explanation be sent uh sent to the insured and to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help. Thank you.
[AGENT][POSITIVE] Yes, you are welcome. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No he just.
[AGENT][NEUTRAL] OK, well, I
[CUSTOMER][NEUTRAL] I just need to finish up with [PII] on the call.
[AGENT][POSITIVE] OK, well thank you all so much for you. Have a great day.
[CUSTOMER][NEUTRAL] OK, I'm gonna, I'm gonna stay on the call.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.