AccountId: 011433970860
ContactId: a0aeafde-d7a8-4dd3-9fc4-ce7e42e4b9bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321679 ms
Total Talk Time (AGENT): 178502 ms
Total Talk Time (CUSTOMER): 129802 ms
Interruptions: 1
Overall Sentiment: AGENT=3.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/a0aeafde-d7a8-4dd3-9fc4-ce7e42e4b9bc_20250114T15:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII]. I'm calling from the office of Dr. [PII], and I have a patient who's going to have a minor surgery, uh, next week, and she tells me that you are her gap insurance, and I want to know how this works and what you guys will cover.
[AGENT][POSITIVE] OK, perfect. Yeah, I can look at some benefits for you and help explain the policy a little. Um, do you by any chance, do you have a good call back number I can get from you real quick, my friend?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much I appreciate that and then would you mind just spelling your name for my notes?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Perfect thank you [PII] did I get that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much and what's your member's policy number today?
[CUSTOMER][NEUTRAL] OK. Oh my God. I have here.
[CUSTOMER][NEUTRAL] This is moving. I got a copy here.
[CUSTOMER][NEUTRAL] I have a payer ID. I have in-hospital benefit certification number, outpatient benefit card number, group number.
[CUSTOMER][NEUTRAL] A payer ID?
[AGENT][NEUTRAL] Either either of those certificate numbers, the inpatient or outpatient one, those numbers will be the same before the letters and I can take either of those.
[CUSTOMER][NEUTRAL] Sure, sure, sure, sure, sure. OK. Uh 02301609 [PII] 8.
[AGENT][POSITIVE] Thank you, thank you. And give me just a moment to get that policy pulled up.
[CUSTOMER][POSITIVE] Definitely.
[AGENT][POSITIVE] Awesome. And can you do me a favor and verify your patient's first and last name and date of birth for me?
[CUSTOMER][NEUTRAL] Yes, her name is [PII]. Date of birth, OK, it's not here. Give me a second. Let me go to her chart.
[CUSTOMER][NEUTRAL] Date of birth of the patient is [PII].
[AGENT][POSITIVE] Wonderful thank you so much. So [PII] is current and active with us. Um, she does have an effective date of [PII], and I can go over some benefits and how the how the plan works. I do just wanna let you know that any benefit information I give you over the phone is just a verification of coverage and never guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And sorry, one second, I am pulling up those benefits, um, so we are her secondary insurance. What we do is we pick up and pay on things that are applied to her co-pay, her co-insurance or deductible for accident, injury, sickness. We don't cover anything routine here, um, and then your patient has, um, do you know if what she's getting done as an outpatient procedure or is it gonna be inpatient?
[CUSTOMER][NEUTRAL] It is an outpatient uh procedure, but it's gonna be done at a hospital. There is not, um, it has to be done at the hospital, yes.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So she does have coverage in an outpatient hospital setting. Um her benefit amount with us is up to $2500 per calendar year and those are things that um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She doesn't have a deductible or anything with us, um, but that can help cover the cost of her co-pay co-insurance and, um, deductible left behind from her major medical. Um, what we'll need here is after you file the claim with her major medical and you get back our explanation of benefits, we will need you to submit the claim form as along with the major medical explanation of benefits so that we can have all of that information to process our claim.
[CUSTOMER][POSITIVE] OK, so she doesn't have to pay. I don't have to charge her. You guys will take, will pick that up.
[AGENT][NEUTRAL] So everything just depends on that claim form and how major medical pays for it so I can't like I can't guarantee payment over the phone.
[CUSTOMER][NEUTRAL] OK, so I'm gonna charge her and could you guys, can I charge her and you guys return the money to her? She's your client.
[CUSTOMER][NEUTRAL] Reimburse her?
[AGENT][POSITIVE] I mean if she has to do it that way, it's, it's a lot easier I think for y'all as medical providers to have that documentation that we require the itemized bill with the diagnosis code all the procedure codes, but yes, if the insured ends up filing a claim with us, um, of course we're gonna, you know, take care of them too. Um, if you file the claim, we send the money to you, and if they file the claim, we'll send the money to them.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. So she doesn't have to pay, you will take care of that. OK. OK. That sounds, that sounds good. And uh all right. I'm gonna take care of that up to $2500. Thank you very much. I'm going to take note and talk to the patient.
[AGENT][POSITIVE] Absolutely. Is there anything else I can help you with today, my friend? Any reference number you need or?
[CUSTOMER][POSITIVE] No, you've been great.
[CUSTOMER][NEUTRAL] Yeah, go reference again, what was your name?
[AGENT][NEUTRAL] Yeah, it's [PII] and the reference is just my name [PII], my last initial B like [PII] in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] C C or B?
[AGENT][NEUTRAL] Oh, [PII], my friend.
[CUSTOMER][POSITIVE] [PII], and today's date. Thank you.
[AGENT][POSITIVE] You bet you hey, it's my pleasure. Thanks for calling APL and I hope you have such a fabulous day.
[CUSTOMER][NEUTRAL] Same to you. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.