AccountId: 011433970860
ContactId: 653697b3-86c8-4202-8d00-7e522a956915
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318839 ms
Total Talk Time (AGENT): 156328 ms
Total Talk Time (CUSTOMER): 118311 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/653697b3-86c8-4202-8d00-7e522a956915_20250103T23:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm with C the Trainer. Um, I have a patient on file here with you guys listed as their insurance, and I just had a couple of questions cause we've never, we've never worked with you guys before. Um, I guess my first question is, do you guys just function as any other regular insurance company would?
[AGENT][NEUTRAL] Uh, yeah, so we, I, I would suppose so. I don't know how other insurance companies work, but we're a limited supplemental company, so we have a lot of different policies out there, um.
[CUSTOMER][NEUTRAL] That's fair.
[AGENT][NEUTRAL] In different plans, but they're all supplemental policies.
[CUSTOMER][NEUTRAL] Makes sense.
[CUSTOMER][NEUTRAL] OK, I guess to specify my question more would be like we submit a claim with you guys and you guys either pay us or pay the patient for their hospital visit.
[AGENT][NEUTRAL] Yeah, if you submit the claim with us, we'll pay the provider and then if the insured submits the uh the claim, we pay the insured.
[CUSTOMER][NEUTRAL] All right, perfect. Um, and then do you guys cover durable medical equipment at all like boots, crutches? The plan that this person has is the
[CUSTOMER][NEUTRAL] Medlink with benefit assignment plan.
[AGENT][NEUTRAL] Yeah, if you actually, if you give me their policy number, I'll look it up and see if we have um a DME rider on that policy for them.
[CUSTOMER][POSITIVE] Oh, perfect. Um, I'm ready whenever you are.
[AGENT][NEUTRAL] Oh, same.
[CUSTOMER][NEUTRAL] Alright, 0244.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2009
[AGENT][POSITIVE] Perfect. And while I'm getting that policy pulled up, Miss [PII], do you mind if I also go ahead and grab a good call back number from you?
[CUSTOMER][NEUTRAL] Yeah, a good call back number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much. And then your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yep. Their name is going to be [PII], and their date of birth is [PII].
[AGENT][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me take a look at this.
[CUSTOMER][POSITIVE] And it is an ER visit if that makes any difference with you guys.
[AGENT][NEUTRAL] Absolutely. So your patient is current and active with us. It looks like this policy has an effective date of [PII], but I do have an updated policy number um to give you if you're wanting it.
[CUSTOMER][POSITIVE] Oh, that'd be great. Thank you.
[AGENT][NEUTRAL] Absolutely, and I have the new policy number is 02792229.
[AGENT][NEUTRAL] And then it does look like they have an outpatient DME rider on their benefits, um, so they could be eligible for benefits on that as well.
[CUSTOMER][POSITIVE] All right, perfect.
[AGENT][NEUTRAL] And then I know you had said it previously that you haven't worked with us before. I do want to let you know we don't need much on file, but you would need to submit a W-9 with your tax ID number on it um for claims to be made payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right perfect and then.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just looking for a fax number to send that to. Is that gonna be [PII]?
[AGENT][POSITIVE] Perfect. So the W9 needs to go to a different fax, um, but I can give that to you. It'll be the other one is where you could fax claims, but
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] For AW 9 we would want to fax it to [PII], and then we would put attention on that to [PII] and then [PII]
[AGENT][NEUTRAL] And then if you wouldn't mind on that cover sheet including a um your name and a contact number in case she needs to reach out to somebody.
[CUSTOMER][POSITIVE] All right, perfect.
[CUSTOMER][NEUTRAL] I think you've answered all of my questions other than um should I like kind of highlight that this was an ER visit or is it kind of the same coverage no matter what?
[AGENT][NEUTRAL] Um, so they do have coverage for outpatient ER visits and inpatient ER visits. So what they'll do is they'll look at honestly the procedure codes and then they'll like figure out what benefits it can fall into, but they do have for both um inpatient or outpatient.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right, you've answered all my questions. Thank you so much for all your help today. I hope you have a great rest of your day and [PII].
[AGENT][POSITIVE] Hey thank you so much you have a great day and [PII] to you as well ma'am.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Bye bye.