AccountId: 011433970860
ContactId: 73a0ba6b-1722-4770-ae36-81d8138a2902
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405459 ms
Total Talk Time (AGENT): 133406 ms
Total Talk Time (CUSTOMER): 111304 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/73a0ba6b-1722-4770-ae36-81d8138a2902_20250603T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, good afternoon. This is [PII] calling from Laredo Sports Medicine Clinic. I would like to know if our facility is in network with your insurance, American Public Life.
[AGENT][NEUTRAL] OK, I can check and see um about the eligibility, the benefits and um whether or not we're in network for you. Can I please get your first name again and your callback number?
[CUSTOMER][NEUTRAL] L
[CUSTOMER][NEUTRAL] [PII] callback number it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It's [PII] policy number, um, it's 02613568.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. His effective date is [PII], and there's no network for him. Uh, he can use his, um, this is a supplemental insurance. So wherever he uses his primary insurance, he can also use this because this helps with deductible, co-pay and co-insurance and secondary.
[CUSTOMER][NEUTRAL] Oh, so this is a uh supplemental insurance.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, he didn't mention that there is a primary insurance. He mentioned that he only has this um insurance. So then, um,
[CUSTOMER][NEUTRAL] Would it be network like to take it or?
[AGENT][NEUTRAL] Yes. So when he uses his major medical insurance,
[AGENT][NEUTRAL] He has to give them this card too.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then when it's billed, we'll need the EOB from the primary insurance carrier.
[CUSTOMER][NEUTRAL] And uh, would there be any um um any office visit co-pay with this insurance or um you all cover the 20% or?
[AGENT][NEUTRAL] No, so the way that it works is um this is just to verify his benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Are you looking for outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] First of all, I did, I don't, I don't even know if we are a network with the supplemental plan. Would you, um, mind checking for us, please?
[AGENT][NEGATIVE] There's no network, there's no network he can use it anywhere he wants to.
[CUSTOMER][NEUTRAL] OK, um, so he can use it anywhere, so then.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK, let's say he comes in and then um he provide us with his primary insurance and then um hands out this insurance so you are like uh when we bill like you are responsible for like whatever the primary insurance doesn't pay.
[AGENT][NEUTRAL] No, no, um, is he coming in as outpatient or is he coming as inpatient?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so this is just to verify his benefits. It's not a guarantee of payment. He has an outpatient calendar year benefit amount of $2400 to use towards deductible, co-pay, or co-insurance. After that $2400 is used up, then he's maxed out his benefit for the calendar year.
[CUSTOMER][NEUTRAL] OK. And then right now there is no accumulations.
[AGENT][NEUTRAL] No, ma'am. He has not sent in a claim for 2025.
[CUSTOMER][NEUTRAL] OK, give me one quick moment, OK? Thank you.
[AGENT][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEUTRAL] Um, thank you for holding, Ms. [PII]. All right, may I please have a reference call number for this verification?
[AGENT][NEUTRAL] Yes, yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Today's date. OK, got it. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're very welcome. I hope you have a good rest of your night and thank you for calling APL.
[CUSTOMER][NEUTRAL] Likewise you too bye bye.
[AGENT][NEUTRAL] Bye bye.