AccountId: 011433970860
ContactId: 87220d40-ee93-419c-9849-17269332c8da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209160 ms
Total Talk Time (AGENT): 119545 ms
Total Talk Time (CUSTOMER): 103070 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/87220d40-ee93-419c-9849-17269332c8da_20250130T19:32_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I have a patient that's coming into my office. I need to verify how y'all could work from what I understand, this is a secondary to her insurance.
[CUSTOMER][NEUTRAL] And I don't really understand, yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] How to, how to, uh, yes, how to file, of course. What is the policy number, please?
[CUSTOMER][NEUTRAL] 1912984.
[AGENT][POSITIVE] Thank you, and I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, the insured's name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] I do appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII], um, I keep forgetting that last [PII].
[AGENT][NEUTRAL] Thank you. Now, the first thing that's uh um on this is that the policy went into effect on [PII], it is active. So what you'll do um uh [PII] is that you will file with their major medical first.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then because we are the secondary or the gap insurance, then you would file through us. And uh what we do for outpatient hospital, we will pick up the deductible, co-payment or co-insurance up to $80,050 and that's just a verification of a guarantee of payment or $8150 for inpatient, again, just a verification, not a guarantee of payment. But that's what you would do is you're gonna file through their major medical first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, of course, uh there will be that deductible, co-payment or co-insurance um and as, as far as pre-authorization or anything like that, uh, you just need to do that with their major medical, you, uh, we just follow their, their policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well this is the problem. The the the major medical can't give me any information. They can't tell me whether it needs to be pre-cer or not. It's ridiculous. I'm, I'm just having such a hard time with them, and I know this particular company Allied Benefits is one of the worst to deal with. I do know that. Do you know anything about them or y'all just the secondary and that's it?
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] We're just a secondary. We're pretty much at their mercy as well, um.
[CUSTOMER][NEUTRAL] OK, so let me ask you this, can I charge her and then she.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Collects from you guys?
[AGENT][NEUTRAL] That is correct. Yeah. Now, when you do that, yes, you, you can certainly do that. Um, they can file the claim themselves. [PII] can do it or you can do it. Now, if it does turn out that that is uh what she's going to need from you is an itemized bill and a diagnosis code. But if you don't mind giving her that, then she can just get her own uh EOB. Yeah, and then we'll pay the benefit to her.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, that is fine. Yeah, definitely.
[CUSTOMER][POSITIVE] Got it. OK, got it, so we can do that.
[AGENT][NEUTRAL] Yes, ma'am. Yeah, you sure can. Now, is this, is there anything else that else that I can help with, or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's it. Well, what address would she, she knows where to mail it to and everything?
[AGENT][POSITIVE] Oh yes, yes, it's actually on our, on her card, um, not only can she mail it in, but we have an online service center which we strongly recommend that they, you know, they download it because that way we get it faster. Usually takes us about 2 to 3 days to get this processed, so yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, well, I, I don't know if y'all ever, I mean, Allied is just very difficult. They, they, they can't really answer any questions and I had another patient of another office and they only cover one thing, but I'm just trying to verify that that's still the way it is and they can't even do that but I appreciate your help because you've been very helpful.
[AGENT][NEUTRAL] What.
[CUSTOMER][POSITIVE] You have a good day.
[AGENT][POSITIVE] Thank you, thank you for contacting APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh,