AccountId: 011433970860
ContactId: 63e5ffb7-681f-47c9-9a00-e1dd48b59715
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301179 ms
Total Talk Time (AGENT): 186711 ms
Total Talk Time (CUSTOMER): 112836 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/63e5ffb7-681f-47c9-9a00-e1dd48b59715_20250321T13:54_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with um Vassar Brothers Medical Center, excuse me, Putnam Hospital Center.
[CUSTOMER][NEUTRAL] We have a patient that's coming into our facility for outpatient surgery. She says that she has, I'm not sure if we're in par or how it works, she says she has some kind of gap insurance with American public life, and she gave me that information. So I'm trying to find out as much as I can about it, and she gave me all the information, her group number and policy number.
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][POSITIVE] Well, you've come to the right place. Uh, we can do it. Uh, [PII], what is the policy number, please?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You might begin with a 0102.
[CUSTOMER][NEUTRAL] Policy number is 19.
[CUSTOMER][NEUTRAL] It's um 1994048.
[AGENT][NEUTRAL] 48. Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] This is for [PII] and I have her date of birth as [PII].
[AGENT][POSITIVE] OK, that's great. And if I could just have a callback number please, ma'am, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. This, uh, this is a secondary or gaff insurance. It's meant to pick up the deductible, co-payment or co-insurance from a major medical. Um, it certainly does have outpatient benefits. Uh, it went into effect on [PII]. It is active. So on outpatient benefits, we will pick up the deductible, co-payment or co-insurance from Renee's major medical, up to $5000 per calendar year.
[AGENT][NEUTRAL] Uh, that's just the verification, the benefits, not a guarantee of payment and what it includes is outpatient hospital, the ER, uh, urgent care, treatment within the physician's office, um, durable, excuse me, I'm sorry, uh, independent labs, um.
[AGENT][NEUTRAL] It uh does all sorts of, yeah, durable medical. So is there anything in particular that I could help with, uh, anything that uh
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, OK, so she has the way it was looking is she has like a $5000 deductible, then it's covered at 100%. So basically she what we were looking for was um the remaining deductible. So you're saying that you, which is like uh $3,195. So basically you'll pick up that difference is what you're saying.
[AGENT][NEUTRAL] Absolutely, yes. Um, now, this is for sickness or accidents, so this is for cosmetic services or anything like that. It doesn't work. But for sickness or accident, uh,
[CUSTOMER][NEUTRAL] No, it's, it's not. She's having
[CUSTOMER][NEUTRAL] It's just like a regular surgery for her gallbladder.
[AGENT][NEUTRAL] That, that's exactly what we, what we are here for is to pick up the deductible, co-payment or co-insurance for that. um, and uh we match her uh major medical. So as long as you're in network with them, you don't need any pre-authorization with us, you'll file through them first and then you will file with us and uh.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, as long as we're in network with who, as long as we're in network with who?
[AGENT][NEUTRAL] With her major yeah, her major medical because you, you, we, there has to be a deductible, co-payment or co-insurance for us to pay. So as long as you, yeah.
[CUSTOMER][NEUTRAL] Right. She's, she has United Healthcare.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And as long as you're in network with them, that's perfect. Um, the, you know, the only, uh, the only thing that we ask is that you, that is that you are in network with the major medical and it and it sounds like you are. And so, um, when you get there, you'll be back, uh, you will, uh, send that to us along with the claim. It usually takes 2, excuse me, 3 to 6 business days for us to process those, but that's exactly what we're here for, [PII] is to pick up that deductible, co-payment or co-insurance for the type of surgery that you're, that you're discussing. So, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need our mailing address, or payer ID?
[CUSTOMER][POSITIVE] OK, that's perfect.
[AGENT][NEUTRAL] Anything at all.
[CUSTOMER][NEUTRAL] Um, I, she, I hope this is it. She said [PII]. Is that correct?
[AGENT][NEUTRAL] That is correct. Now, we also have a website [PII].
[AGENT][NEUTRAL] [PII] and you can file through there and actually watch the process of the claim from where we get it to where we process it to where we pay it out. So if you want to do that or we've also got a fax, um, but yes, uh, that's what you would do is you file through United first and then us and then we will get that taken care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and your name again is?
[AGENT][NEUTRAL] My name is [PII]. Um, and if you have any questions as you're filing the claim, just let us know. Uh, that's what we are here to to help with, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's perfect. And um is there a call reference number, [PII]?
[AGENT][NEUTRAL] Yes, it's my name and today's date, and the first letter of my last name is [PII], so it's gonna be [PII] and today's date is the [PII] already. So yeah, that's what our, our uh reference will be.
[CUSTOMER][POSITIVE] Oh, yes, wow.
[CUSTOMER][POSITIVE] OK, that sounds perfect, [PII]. Thank you so much. Have a good day.
[AGENT][POSITIVE] OK, thanks for contacting EP have a.