AccountId: 011433970860
ContactId: 80598491-a0ef-4559-9aa5-e5af8142d061
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406470 ms
Total Talk Time (AGENT): 148188 ms
Total Talk Time (CUSTOMER): 229628 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/80598491-a0ef-4559-9aa5-e5af8142d061_20250110T21:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII] my name is [PII] very similar um I'm calling from a um a medical provider, um, and I have a patient who, um, I, I believe has you guys as like a supplemental insurance and I've never worked with you before so before I confirm for her that we can take her on as a patient, I just wanna kind of like I guess know how it works and see if.
[CUSTOMER][NEUTRAL] Is it, is it like a network thing where I have to be in network with you and if I'm, if I am in network or not in network, I, I kind of am just confused because I've never um worked with American public life um or meddling before.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah, uh, number here is [PII], and that is direct to my desk.
[AGENT][NEUTRAL] Thank you, [PII]. What is the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, it is 02350207.
[AGENT][NEUTRAL] All right, thank you. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] That that would be [PII] and her date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with eligibility and policy information for [PII]. Her policy is my pleasure. Her policy is active as of [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And this is a secondary policy to her primary insurance?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And as far as network goes, there's no network on this policy. It follows the guidelines of the major medical.
[CUSTOMER][POSITIVE] Perfect so her primary is Blue Cross, so as long as I'm in network with her Blue Cross we're fine.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK perfect so I am definitely a network with her Blue Cross um now is this something that um where I as the um as the medical provider um would send you claims or does she have to get reimbursed herself after the fact? How does that work?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if the provider files a claim, then we would pay the provider direct.
[AGENT][NEUTRAL] It, it
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] It does have assignment of benefits.
[CUSTOMER][NEUTRAL] OK perfect do you guys do electronic uh claims or is it all mailed in?
[AGENT][NEUTRAL] You can submit it electronically now we'll always need the Blue Cross Blue Shield um EOB as well.
[AGENT][NEUTRAL] But our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or you can fax it or mail it directly to our claims department.
[CUSTOMER][NEUTRAL] OK, so the electronic payer ID was 60801 or the fax or um address to mail it to are probably what's on the back of the card, right? The PO box in [PII] and the fax number on the back of the card?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's correct. It comes straight to our claims department.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Beautiful. That's what I have here. OK, so probably what we'll do is, um, we'll probably just send it directly then we don't have to deal with, um with the patient handling it um now do you guys uh reimburse at like 100% of what the primary doesn't cover? Is there a percentage or how does that work?
[AGENT][POSITIVE] So it's a benefit, [PII] What type of benefits are you needing?
[CUSTOMER][NEUTRAL] So she is um she's currently admitted to the hospital. She's gonna go home on tube feeding so she's getting a G tube put in um and we'll be getting tube feeding, so we'll be providing um tube feeding supplies and formula.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for the facility for the hospitalization, she does have coverage up to $3500. That is a per calendar year benefit.
[AGENT][NEGATIVE] And of course at this time for [PII] she has not used any of that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and so let me see where did I put that information?
[CUSTOMER][NEUTRAL] Oh beautiful so her um her Blue Cross deductible is $2000. So essentially when we bill Blue Cross, obviously they'll, it'll it'll go to her deductible and then we'll bill you guys and that will get paid at 100% up until $3500.
[AGENT][NEUTRAL] That is correct, if it is a payable benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and how is it?
[AGENT][NEUTRAL] And it should be.
[CUSTOMER][NEUTRAL] OK, is it payable based on the Blue Cross plan or based on a plan like or do you have your own limitations?
[AGENT][NEUTRAL] So it will be for medical necessity which or illness or injury and uh depending on what the um primary applies to the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, perfect. Now is that something that we're able to provide medical documentation ahead of time or is it something where like it would come after the fact if if we had if there's any questions, we would provide medical documentation.
[AGENT][NEUTRAL] Medical documentation is usually not required, usually just the UBO4 and the EOB is sufficient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Beautiful, um, I think that that might be all of my questions then. now do you have, um, do you pay at like the primary contracted rate, um, or do you pay like a, like a, have you, do you have your own contracted rates that you pay at for certain codes, uh, or is it based primary like completely off the primary?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's completely off the primary. There's no contractual involvement in the processing of our claim.
[CUSTOMER][POSITIVE] OK perfect, paid it off primary.
[AGENT][POSITIVE] You're asking good questions.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Thank you, I try, um, OK, I think that, I think that that might be all my questions then. um, I'm gonna reach out to her primary to see if they require their own authorization, but, um, all the documentation I have looks like this is pretty straightforward, um, then that is all that I needed is there do you do like reference numbers for your phone calls by any chance?
[AGENT][NEUTRAL] Sure, reference number would be my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] And it's been a pleasure to help you with those benefits. Now, I do need to advise that all benefits given over the phone is a verification of coverage, not a guarantee of payment. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] That is all that I needed thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] My pleasure and thank you for calling APL. You have a great day and a happy weekend.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.