AccountId: 011433970860
ContactId: 8a4c277f-3397-48cb-ae71-3656a051675c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291480 ms
Total Talk Time (AGENT): 119341 ms
Total Talk Time (CUSTOMER): 128023 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/8a4c277f-3397-48cb-ae71-3656a051675c_20250411T12:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Urology Medical specialist. I wanted to just um
[CUSTOMER][NEUTRAL] Obtain like the benefits information for you guys as a secondary, are you able to help me with that?
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, it's.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 02415249 M like Mary, L like Larry 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's for a specialist office visit.
[AGENT][NEUTRAL] OK, under this policy for office visits, let's see.
[AGENT][NEUTRAL] We cover up to $400 per day, and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, sorry, I'm just notating everything. Um, so you cover up to $400 per day for the co-insurance and and the deductible, um, after the primary insurance bills it to you guys.
[AGENT][NEUTRAL] Right, that's correct. And what normally happens is that um the primary, the doctor will
[AGENT][NEUTRAL] Bill the primary insurance first and once the doctor provider receives the EOB then they'll bill us, they'll send us the claim form along with the EOB so that, so it doesn't automatically comes from the primary insurance. If the bill comes from the provider.
[CUSTOMER][NEUTRAL] Got you. OK, OK. I think I understand, uh, because the patient was concerned about paying the co-pay, I guess.
[CUSTOMER][NEUTRAL] Um, so yeah, so she would have to still pay that since that's not covered.
[AGENT][NEUTRAL] Right, for the office visit.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right, for car insurance after finally.
[CUSTOMER][NEUTRAL] OK, so, um, I guess, uh, just to be, you know, on the safe side and, and clarify, since she's doing a stent removal here in the office.
[CUSTOMER][NEUTRAL] Um, normally we're supposed to collect from the patient, but I just wanna, you know, ask you to make sure is that.
[CUSTOMER][NEUTRAL] Um, I guess gonna be covered by you guys or, or are we still supposed to bill the patient?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, is the primary insurance covering part of it? We can't guarantee payment over the phone. We have to review the claim first. But um if it's related to an illness or an injury, and it's not for like a screening, and also if the primary insurance covers it, then more than likely it will be um covered by us as well, all except for the co-pay, of course.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And it'll be covered for up to $400.
[CUSTOMER][NEUTRAL] Um, let me see
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK let's see here.
[CUSTOMER][NEUTRAL] Yeah, because I see, um, I pulled up her primary insurance just to kinda make sure and her individual deductible is just about met, so she would have to pay I guess for a portion of it um and then the rest I guess essentially would be billed to the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, uh, no problem then can I get the reference number for the call please?
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name and today's date. My name is [PII]. um it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, that'll be all. Thank you so much.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm