AccountId: 011433970860
ContactId: 632b100b-35da-4e1a-a112-348eae60c9bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268980 ms
Total Talk Time (AGENT): 105506 ms
Total Talk Time (CUSTOMER): 104589 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/632b100b-35da-4e1a-a112-348eae60c9bf_20250306T19:42_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII], and I'm calling from a provider's um office as courtesy to the patient. Um, I wanted to know, she has, um, Aetna as primary, and then she has, uh, American Public Life as a secondary. Do you guys pick up the deductible and co-insurance that Aetna doesn't cover?
[AGENT][NEUTRAL] OK, so it depends on what type of service, uh huh, go ahead with the policy number.
[CUSTOMER][NEUTRAL] If I gave you the patient information, mhm, OK.
[CUSTOMER][NEUTRAL] OK. Uh, it is, hold on a 2nd. 0, 02477074.
[AGENT][NEUTRAL] OK, what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what type of service is it an office or outpatient facility hospital?
[CUSTOMER][NEUTRAL] It's going to be an in office procedure. It's gonna be sinus surgery.
[AGENT][NEUTRAL] An officer, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you for that. So I'm showing an effective date of [PII] policy is active at this time.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Would you need like CPT codes or CPT codes or anything like that help you or?
[AGENT][NEGATIVE] No, no, no, no. That's a a sickness that you just gave me. I got the, the description that you gave me. You said sinus, sinus.
[CUSTOMER][NEUTRAL] Sy surgery. Mhm. It's a septoplasty being done in the office.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Mhm. Mhm. And it's not elective or anything like that, correct? It's for medical concern?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So treatment in the physician's office can be considered, uh, covered treatment can be considered under this policy under the outpatient benefit and that amount.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's up to $5000 per covered person per calendar year.
[AGENT][NEUTRAL] And any information provided is verification, not a guarantee of payment?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this uh policy does assist with amounts applied towards the major medical deductible, co-insurance, and or co-pay amounts of covered treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see if any of that has been used.
[AGENT][NEUTRAL] Yeah, currently I'm showing that we've paid up that outpatient benefit $952.36.
[CUSTOMER][NEUTRAL] OK, so she has about 952. What was the other? I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She's used 952 of the $5000 maximum.
[CUSTOMER][NEUTRAL] OK, OK, and I'm sorry, I, I, I think you said your name and I did not catch it. I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's OK. It's [PII], and you'll use my name in today's date as reference for today's call. And any other questions, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so you said you don't need that, um, OK, no, that's all there, so what she would do is she would wait for Aetna to process it and then, um.
[CUSTOMER][NEUTRAL] We will, uh, we will file it to Aetna first, have Aetna process it. Does the patient have to file the claim to the secondary, or can we do that?
[AGENT][NEUTRAL] Yeah, the provider will generally submit it to the secondary payer.
[CUSTOMER][POSITIVE] OK. OK. All right, well thank you so much, Miss [PII]. You have a wonderful day, OK?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] You, you're welcome, [PII]. Thanks for calling APL. Have a good day as well.
[CUSTOMER][NEUTRAL] Alright you too, hon.
[AGENT][NEUTRAL] Bye bye.