AccountId: 011433970860
ContactId: 61ea9161-5b5a-4f22-beea-49f0e1552338
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254350 ms
Total Talk Time (AGENT): 114895 ms
Total Talk Time (CUSTOMER): 92585 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/61ea9161-5b5a-4f22-beea-49f0e1552338_20250211T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] For calling
[CUSTOMER][NEUTRAL] Uh, yes, I just need to verify, uh, eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the eligibility and benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. My name is [PII], right? And uh my best contact number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, yes, the number is 01816168.
[AGENT][NEUTRAL] And that was 01816168. Correct? OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active, it's been effective since [PII], and you said you needed the benefits as well.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And this is for outpatient?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK. So for outpatient, the policy will pay up to $1500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so is this
[CUSTOMER][NEUTRAL] Do you guys pay the patient or do you pay the hospital?
[AGENT][NEUTRAL] So it could be both. So we pay towards the copay, the deductible and co-insurance of cover charges after primary. So like if they have to pay a co-pay, you know, to be seen, then once we receive that claim on the back end, we can reimburse them for the claim, I'm sorry, for the co-pay, or um if there's something still owed to you after primary pays, we can do both. It'll just be up to that $1500 per day.
[CUSTOMER][POSITIVE] Got you, so we can bill you guys.
[AGENT][NEUTRAL] Yes, you bill us after their primary and
[AGENT][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] Got you. So whatever they whatever they have to owe, we subtract 1500 from that, and that's what the patient owes.
[AGENT][NEUTRAL] Mhm. It depends. So when you file the claim, so you're gonna file with primary, they're gonna pay based on their policy, then you file with us directly after primary with their explanation of benefits, so we can see what was charged, what the insurer paid, what primary paid and what's still owed.
[AGENT][NEUTRAL] So it depends on how you all do your billing. If you
[AGENT][NEUTRAL] You know how they can be billed. If they're billed, then we'll handle them on the back end once we receive the claim. If they have, if they have to pay to be seen, then they'll have to pay and then once we receive the claim, we can reimburse and pay you all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you. OK, so, OK, I get it I get it I get it, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] Um, OK, so if they have if they have to pay ahead of time they have to pay ahead of time, but if they're just billed you guys can be billed and then they can pay later.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] So it's kind of like a gap, but we were after primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] If pay ahead of time reimbursed.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I think that's everything I needed to know, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that's everything I needed to know. Thank you so very much.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye.