AccountId: 011433970860
ContactId: 8c41a8f0-f692-4ea9-9517-f1aa37201290
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240419 ms
Total Talk Time (AGENT): 131186 ms
Total Talk Time (CUSTOMER): 90943 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/8c41a8f0-f692-4ea9-9517-f1aa37201290_20250425T14:56_UTC.wav
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[AGENT][NEUTRAL] I'macking ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling on behalf of a patient that's gonna be having surgery on um Monday, and she had, she gave me this information to call you guys because she's saying that you guys will cover her $600 copay. I've never called like this before, so I'm not sure what kind of information you need.
[AGENT][POSITIVE] I can certainly help with um benefits and uh with whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you. What is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] It is 021.
[CUSTOMER][NEUTRAL] 02761.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][POSITIVE] OK, I appreciate that. If I can have a callback number while I'm looking up the policy, please, ma'am?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] I appreciate that. Thank you. Now the policy went into effect on [PII]. It is active. This is a secondary or gap insurance. It's meant to pick up the deductible, co-payment or co-insurance from her major medical.
[AGENT][NEUTRAL] And so what we will do for outpatient surgery is that we will pick up that deductible, co-payment or co-insurance up to $500 per calendar day. Now, that's just a verification of the benefits. It's not a guarantee of payment, but that is, that is what we will do um for this type of situation. Now, this is an outpatient um surgery, is that correct or is it inpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, well, that, that is what we will do. That is the benefit. It's uh $500 per calendar day. Again, just a verification, not a guarantee of payment, but it, it renews each and every calendar day.
[CUSTOMER][NEUTRAL] 500 per calendar day so she already had the hospital pick that up.
[CUSTOMER][NEUTRAL] Does she have to pay us because it's gonna be same day.
[AGENT][NEUTRAL] Well, um, it's, I guess it really just depends, uh, you said that the hospital picked it up. Is that she's already paid the, the hospital, is that?
[CUSTOMER][NEUTRAL] Uh yeah, she said that she the hospital was able to get the copay from you guys.
[AGENT][NEUTRAL] Well, they, they wouldn't have gotten it from us. Yeah, they probably got it from her because we only um we only get the claims after the event, um, so.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] That's what I thought. OK, so she has to pay and then she sends you the claim, correct?
[AGENT][NEUTRAL] She can certainly do that. Um, she'll need an itemized bill from you, uh, letting us know the charges and then the diagnosis code for that, but yes, um, [PII] can certainly turn in that claim herself and the benefit would then be paid to her or, or the provider can send it. It, it's, it works both ways.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so she basically how it works is she pays us and then she gets reimbursed.
[AGENT][NEUTRAL] Well, it, yes, it, it actually works both ways. [PII] she can, you can, um, either, uh, bill us and then get the money from us or you can get it from her. It just really depends on, on what you want to do, but it sounds like you've already gotten the money, so if that is indeed the case, then she can send some. Oh, you haven't? OK, well, if you, um, whatever it is that you decide to do, um, she can either turn in the claim, uh, or you can, um, we just pay whoever it is turns in the claim, and that's the benefit amount that we would pay up to.
[CUSTOMER][NEUTRAL] No, not yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, because we're, we don't really, we would have to have the claim reimbursed to her, I think.
[CUSTOMER][NEUTRAL] How that works OK.
[CUSTOMER][NEUTRAL] All right, so I will contact the patient.
[AGENT][NEUTRAL] OK. Is there anything else at all that I can help with on the secondary gap insurance?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thanks for contacting AT have a good day.
[CUSTOMER][NEUTRAL] All right.