AccountId: 011433970860
ContactId: 9925e9b0-1c1d-4095-bc4c-bb7152fc5ad6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276290 ms
Total Talk Time (AGENT): 103290 ms
Total Talk Time (CUSTOMER): 105505 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/9925e9b0-1c1d-4095-bc4c-bb7152fc5ad6_20250218T16:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon, [PII]. My name is [PII], and initial my last name, [PII], checking for eligibility, patient eligibility and benefit.
[AGENT][NEUTRAL] OK, I can help you with eligibility and benefits, [PII], can you please give me your callback number and the name of the facility you're calling from, sir?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, sure. Callback number that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's the direct line and the facility or the office name is Marjorie Nolan Conn LLC.
[AGENT][POSITIVE] OK, thank you so much. I appreciate you giving me that information and what is the patient's name, date of birth and policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, patient's name I have is [PII].
[CUSTOMER][NEUTRAL] [PII]. And the member ID number I have is 0221.
[CUSTOMER][NEUTRAL] 648-7 M as in Mary, L as in Larry, number 8.
[AGENT][POSITIVE] OK, thank you I appreciate that. I'm gonna look that policy up for you real quick.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] You're very welcome. OK, I do show that [PII] does have an active policy with us, and her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. This is a supplemental insurance policy. It's a gap insurance. It's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $1000.
[AGENT][NEUTRAL] And she also has an outpatient per calendar day benefit of $200 or $200.
[CUSTOMER][POSITIVE] Maximum benefit per day.
[AGENT][NEUTRAL] Yes, it's 200.
[CUSTOMER][NEUTRAL] OK. Is it a commercial plan or is it a like a Medicaid or Medicare, something like that? This is the first time I'm calling this uh insurance, so I'm not really uh well versed when it comes to like a gap plan.
[AGENT][NEUTRAL] Right, it's a standalone company um um called APL.
[AGENT][NEUTRAL] We build our own separately from other insurances.
[CUSTOMER][NEUTRAL] OK. So you'll always be the secondary insurance.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. But what if, for example,
[CUSTOMER][NEUTRAL] The primary insurance did not pay or rejected the claim. For example, we're not contracted with the, with the policy, it's an HMO plan and there's no out of network coverage and claims will be sent directly, automatically be submitted to you guys, right?
[AGENT][NEUTRAL] OK, so since we only pay help with deductible, co-pay, and co-insurance, if the primary doesn't pay a deductible co-pay or co-insurance, then we don't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You don't own, OK, you don't pay if the primary insurance don't pay. OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Just give me one sec. I'm documenting this information. Sorry.
[AGENT][NEUTRAL] Yes, sir. No, that's fine. Take your time.
[CUSTOMER][POSITIVE] OK, cool.
[CUSTOMER][NEUTRAL] That's all. And before I end the call, can you ask for a reference number if you have one?
[AGENT][NEUTRAL] Yes, sir. Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK. Sorry. And today is [PII].
[CUSTOMER][POSITIVE] Cool. Thanks again for your help. I really appreciate it and you have a wonderful day.
[AGENT][POSITIVE] You too thank you for calling APL [PII]. I hope you have a good rest of your week.
[CUSTOMER][NEUTRAL] Do the same. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, sir.