AccountId: 011433970860
ContactId: 6e73e3cb-4546-402a-83b4-9c4964b0dc94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 161759 ms
Total Talk Time (AGENT): 93090 ms
Total Talk Time (CUSTOMER): 46877 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/6e73e3cb-4546-402a-83b4-9c4964b0dc94_20250131T16:16_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] Um, I need to, uh, check on to see what, uh, plan this is, um, my, uh, patient has a this as a secondary.
[AGENT][POSITIVE] OK, well I can definitely help you with the um eligibility and benefits, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01841277.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[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. Um, so I am showing the policy is active, it's been effective since [PII]. This is their secondary insurance policy, so we pay towards the copay, the deductible and co-insurance of coverage charges after United Healthcare.
[CUSTOMER][NEUTRAL] OK, so once United Healthcare starts paying then you guys will.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Pick up the 20% co-insurance that it doesn't pay.
[AGENT][NEUTRAL] Well, it depends on what's being done because primary has its own benefits and our policy has its own benefits. So if it is something that's covered on the secondary as well, then yes, we can pay towards it. Um, so primary will be billed first and then um once we're billed, well, we're billed second and then we'll see the explanation of benefits so we can see what, like if a reimbursement is needed to the patient or if we need to pay you all, we'll be able to see that then.
[CUSTOMER][MIXED] OK, but you guys won't um.
[CUSTOMER][NEUTRAL] If everything's going towards their deductible, you guys won't pay until their deductible is met, right?
[AGENT][NEUTRAL] No, that's not. So it's two different policies. Primary applies the policy, we help pay, um, primary applies the deductible, we help pay it. So if you require the member to pay the deductible to be seen, then once we get that explanation of benefits when we receive the claim, we can see they've paid it and they can be reimbursed for that or you all can be paid if something is still left over or both.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][POSITIVE] Um, thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] No thank you bye bye.
[AGENT][POSITIVE] Alright, well thanks for calling APL.