AccountId: 011433970860
ContactId: a93c59e2-05b2-47ca-95ce-cd6c0e0a2280
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235710 ms
Total Talk Time (AGENT): 117501 ms
Total Talk Time (CUSTOMER): 121051 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/a93c59e2-05b2-47ca-95ce-cd6c0e0a2280_20250411T15:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Listen, my name is [PII] and I'm calling from Houston Healthcare HCA at [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a patient coming in on Monday and she provided this information as being like her gap insurance.
[CUSTOMER][NEUTRAL] And she said that they would pick up, you know, whatever her insurance didn't cover, and the reason that I'm calling you guys is I need to verify the benefit what she's looking at or what they're asking her to pay here at the facility when she comes in is her remaining deductible, and I didn't know if you guys paid the deductible or not. Can you help me with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you with that today. What is a good callback number please, ma'am?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's policy number please, ma'am?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She gave me all these numbers, policy number 02573196.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh the last name is [PII] and her first name is [PII], and her birthday is [PII].
[AGENT][POSITIVE] All right, thank you. Well, it would be my pleasure to go over benefits for Ms. [PII]. And [PII], I'm showing that her policy is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And yes, this is a secondary policy to her primary insurance.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] And what type of coverage are you needing? Is that outpatient or inpatient or?
[CUSTOMER][NEUTRAL] Um, yes, it's a, uh, outpatient procedure. She's having a, um, I'll tell you what she's having an EGD.
[AGENT][NEUTRAL] OK, well, she does have outpatient coverage. The maximum we can pay per calendar year is $1000 and that is what we can pay toward her deductible or co-insurance of her primary. Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And [PII] at this time, she has not used any of that benefit for [PII].
[CUSTOMER][NEUTRAL] I got it, so y'all will pay $1000 towards her deductible, but she still owes $1600 so then she still owe me $600. Do I understand right?
[AGENT][NEUTRAL] Uh well, we don't determine patient responsibility because we're secondary, um, yeah.
[CUSTOMER][NEUTRAL] OK, but regardless, I'll pay $1000. And listen, does it automatically come to you guys?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] It does not. So once you received the EOB from the primary insurance, then you would file with APL.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and the facility does that. The patient doesn't send it, correct?
[AGENT][NEUTRAL] If the facility will send it, that's actually marvelous. Um, you know, if you don't well.
[CUSTOMER][NEUTRAL] OK, well I'll put it in and see how that works.
[AGENT][NEUTRAL] Yeah, if you don't file secondary, then the patient would have to be responsible for filing the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, no, no, I think they'll file it for her. That sounds good. OK, awesome is there.
[AGENT][NEUTRAL] But we do have assignment of benefit.
[CUSTOMER][NEUTRAL] Yeah, I guess that's what I'm trying to say. OK, is there a reference for our call today?
[AGENT][POSITIVE] It's going to be my name and today's date, and I spell my name [PII]. And Miss [PII], it's been a pleasure to help you with those benefits. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, that's it. Thank you kindly for your help.
[AGENT][POSITIVE] My pleasure and thank you for calling APL [PII]. I hope you have a lovely weekend.
[CUSTOMER][NEUTRAL] All right. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.