AccountId: 011433970860
ContactId: 891bef7f-d5e4-466e-bd6b-d02d406d79f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269359 ms
Total Talk Time (AGENT): 126978 ms
Total Talk Time (CUSTOMER): 107184 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/891bef7f-d5e4-466e-bd6b-d02d406d79f4_20250116T18:21_UTC.wav
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[AGENT][POSITIVE] Thank you for calling and APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Doctor [PII]'s office, and I need to get some benefit information for a patient.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits. Can you please give me your callback number just in case our call is dropped.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] The patient is [PII].
[AGENT][NEUTRAL] OK, and patient's date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, and then what is the patient's policy number, please?
[CUSTOMER][NEUTRAL] I have it as 024.
[CUSTOMER][NEUTRAL] 64412.
[AGENT][NEUTRAL] OK, let me pull in that policy real quick for us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is just to verify her coverage. It's not a guarantee of payment. She has a supplemental insurance policy that is billed secondary to the primary. It is a gap insurance that helps with deductible, co-pay or co-insurance, and she has an inpatient benefit amount.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Per covered person of $4000 per calendar year.
[AGENT][NEUTRAL] And then she also has an outpatient benefit amount.
[AGENT][NEUTRAL] And I'll tell you what that is. I'm pulling it in now, and the outpatient benefit amount is also $4000 per calendar year.
[CUSTOMER][NEUTRAL] OK, if I'm understanding correctly, you, you all are the secondary and you will pick up copays or deductibles even when services are rendered in the office.
[AGENT][NEUTRAL] Let me see if she has office visits because it's subject to how the policy is written.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has
[CUSTOMER][NEUTRAL] That's what I
[AGENT][NEUTRAL] Outpatients and physician's office on her policy, so yes, office visits are covered.
[CUSTOMER][NEUTRAL] OK, so because I know her, her primary plan that has a $60 copay and a deductible, so we don't charge her anything we bill you and you all will pick up the, the copay and the deductible on the ultrasounds.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, um, now we're billed secondary. The primary is billed first, and then when claim comes through, you'll have to have the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Right, and then
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, right, and then they bill bill you with the explanation of benefits and you would pick up what they applied to the patient's responsibility.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, for deductible, co-pay or co-insurance, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, that's what I needed to find out because I know some do and some don't or some will cover deductible but not the copay, so I wanted to be sure before charging her when she comes in.
[AGENT][NEUTRAL] Right, I understand.
[CUSTOMER][POSITIVE] Perfect. That's a good she's got a good plan.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] Yes, she does.
[CUSTOMER][NEGATIVE] Because I know I called back in [PII], she must have changed it. Um, they had told me that it didn't cover the copays.
[AGENT][POSITIVE] Right, now, this one does cover.
[CUSTOMER][NEUTRAL] Back in December.
[AGENT][NEUTRAL] Yeah, this does cover deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] Perfect. Alright, I appreciate your time and help. Do you give reference numbers for the call?
[AGENT][NEUTRAL] Yes, ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Oh OK perfect thank you so much for your time.
[AGENT][POSITIVE] You're welcome you have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye, Ms. [PII].