AccountId: 011433970860
ContactId: 6a5b3b73-9733-4599-a3a2-f4e06a97dba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251139 ms
Total Talk Time (AGENT): 155674 ms
Total Talk Time (CUSTOMER): 62490 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/6a5b3b73-9733-4599-a3a2-f4e06a97dba4_20250210T20:59_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from the ASR group. I need to find out if we are in network with you before this patient, and I also need to find out the benefits.
[AGENT][NEUTRAL] Yes, I can help with uh business and and that, um, [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Policy number is AH 795-0426.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. And how do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII]. OK, let me see what we can find here.
[AGENT][NEUTRAL] While I'm looking that up, if I can have a callback number please in event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And I'm sorry, uh, [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The policy number is 02320079. Now this is a gap for secondary insurance.
[CUSTOMER][NEUTRAL] 023200 what what is 0079 OK.
[AGENT][NEUTRAL] 79
[AGENT][NEUTRAL] Yeah, let me do it, let me do it again. It's uh 0232.
[AGENT][NEUTRAL] 0079. And this is a gap or secondary insurance that picks up the deductible co-payment or co-insurance from the major medical. So as far as um a network, uh, you need to be in network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With, uh, with the major medical.
[AGENT][NEUTRAL] So if APL just follows the, the major medical, so there's a deductible, co-payment or co-insurance, uh, then, then we, we will pay that. Now for outpatient services, we pay up to um
[AGENT][NEUTRAL] $6000 per calendar year, uh, for inpatient services, we pay up to $6000 per calendar year, just a verification, not a guarantee of payment. That's for, um, hospital settings only inpatient or outpatient hospital or treatment within a physician's office, but that's what we do. Um, we will pick up the deductible co-payment or co-insurance, but you've got to be in network with the with the major medical so that there will be that deductible, co-payment or co-insurance.
[AGENT][NEUTRAL] Now, if you're, if you're not in network with their major medical, then, you know, and, and they don't put any of the benefits towards the deductible, co-payment or co-insurance, there's not much that we can do.
[CUSTOMER][NEUTRAL] OK, I don't, it seems like y'all the primary is what he has up here.
[AGENT][NEUTRAL] No, no, we're not the pri we're, we're never the primary. We're the, we are the secondary insurance. Now, he gets this through his, uh, he gets this through his employer. So I'm going to see here what we've got. He may probably has United Healthcare. I would check with that. I would check to see that he has, uh, his United Healthcare card. That's very likely what he has, uh, is a major medical, but we are, we are never, never, never the major medical. We are, we are a secondary insurance.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so Ally.
[CUSTOMER][NEUTRAL] Is secondary to the UHC.
[AGENT][NEUTRAL] Uh, no, no, we, we, we are secondary. American public life.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Which is what we are.
[CUSTOMER][NEUTRAL] OK, so somebody put it in the computer wrong. OK, give me a minute just.
[AGENT][NEUTRAL] Yeah, so, so what, yeah, however they did it, you're, you'll put APL as being the secondary.
[CUSTOMER][NEUTRAL] Jesus.
[CUSTOMER][POSITIVE] Alright, I got it. I'm gonna figure it out.
[AGENT][NEUTRAL] OK, is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, ma'am, I hope you have a wonderful day.
[AGENT][POSITIVE] OK, thanks for contacting ATL you have a very good day.