AccountId: 011433970860
ContactId: aa7a5784-64e9-4cf5-b622-586703516591
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604479 ms
Total Talk Time (AGENT): 243322 ms
Total Talk Time (CUSTOMER): 273273 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/aa7a5784-64e9-4cf5-b622-586703516591_20250328T12:31_UTC.wav
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[AGENT][NEUTRAL] You're gonna be.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, good morning, can you hear me?
[CUSTOMER][NEUTRAL] You
[AGENT][POSITIVE] Yes, I can hear you, sir. Good morning.
[CUSTOMER][NEUTRAL] Good morning sir. Yeah, we're calling from admissions department of Kealty Hospital. We wanted to verify eligibility for one for a patient that came here with an insurance.
[AGENT][NEUTRAL] OK. Uh, I'm sorry, you say your name is?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Just yet.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, can you hold for me one second, please?
[AGENT][POSITIVE] Sure. Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello? Yeah, sorry about that. It just, uh, someone came to the window, uh, yeah, um, what, what else did you, did you need?
[AGENT][NEUTRAL] Yes sir
[AGENT][NEUTRAL] Let me ask you something. Do you want to do this in Spanish or you prefer to do it in English?
[CUSTOMER][NEUTRAL] However you prefer.
[AGENT][NEUTRAL] Because you're calling to the Spanish line, cause you're calling to the Spanish line. That's, that's.
[CUSTOMER][NEUTRAL] Um, yeah, I don't mind whatever you prefer.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] What is the policy number for the member so I can find his information?
[CUSTOMER][NEUTRAL] Uh, I don't know. I, I do have the card, but I, I, I see the room number and, uh, on the bottom says in hospital outpatient benefit, uh, it says a number, yeah, but it changes the last one.
[AGENT][NEUTRAL] OK, one of
[AGENT][NEUTRAL] Yeah, one of those is, uh, I mean, OK, uh, either or is the policy number.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] The ones that you mentioned at the bottom.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] So I'm gonna give you outpatient benefit first that would be 017.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0 178064.
[CUSTOMER][NEUTRAL] 6 MLN 8.
[AGENT][NEUTRAL] OK, and before we continue, could you please provide me a callback number?
[CUSTOMER][NEUTRAL] So, inpatient would be 7.
[CUSTOMER][NEUTRAL] Yeah, 305
[CUSTOMER][NEUTRAL] 264
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 5252 and the extension would be 1715.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1715? Is this, is the extension? All right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Give me one second, let me see what I can find for this policy.
[AGENT][NEUTRAL] Could you verify the name of the patient and date of birth?
[CUSTOMER][NEUTRAL] [PII], the last name and date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Can you repeat one more time the date of birth please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you very much. You're calling in regards of uh benefits and eligibility for the patient?
[CUSTOMER][NEUTRAL] Yeah, yeah, because we don't have the portal we cannot, you know, verify it via portal, so we have to go.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me start with this policy. It's um it's a supplemental plan. It's a gap plan.
[AGENT][NEUTRAL] We cover the copay, co-insurance and deductible applied to every.
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on, hold on, sorry, sorry, sorry, one second please, yeah, I'm gonna.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Alright, sorry, you say it's a supplemental?
[AGENT][NEUTRAL] Yes, it's a supplemental plan.
[CUSTOMER][NEUTRAL] Supplemental yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, this policy covers the co-pay, co-insurance and deductible applied after the primary insurance.
[CUSTOMER][NEUTRAL] Coins and deductible after primary.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Correct. And also before I give you any information about the benefits, I have to let you know that this is only a verification of coverage. It is not a guarantee of payment. This is policy disclaimer, of course.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, of course, uh, let me ask you, the, the, the primary insurance you're referring to in this case would be Ahmed, right? Because that's the other insurance he gave you, but he may have another one, that's the AMed, right?
[AGENT][NEUTRAL] The policy covers it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we don't have that information. No, we don't, we don't see what who's the primary insurance for the member. What we do is we, we made a, uh, a contract directly with his employer.
[CUSTOMER][NEUTRAL] Oh, you don't see that?
[CUSTOMER][POSITIVE] No, no worries.
[CUSTOMER][POSITIVE] No, no worries, no worries. OK, so sorry for interrupting.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Uh, for outpatient benefit, the policy offers a maximum of $2500 per calendar year for, um, for outpatient procedures.
[AGENT][NEUTRAL] And as of today, the patient hasn't used any benefits yet.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so is this a reimbursement plan or the other category?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What do you mean out category?
[CUSTOMER][NEUTRAL] Meaning the yeah yeah OK so alright so.
[CUSTOMER][NEUTRAL] Uh, he's got a responsibility of X amount, let's say, with the primary insurance. He would pay us and then you would reimburse him or we send you the bill directly to you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You can send us a bill directly.
[AGENT][NEUTRAL] You can send those to you.
[CUSTOMER][NEUTRAL] Bills are sent directly.
[AGENT][NEUTRAL] Correct, you can send us a bill, the original bill that you sent to the primary insurance and then you, and also you, you need to attach a copy of the explanation of benefit from primary. So what you have to do is you, you have to file the claim first to primary when primary replies to you, then you file the claim with APL so we can cover the other part or the part has been applied as a deductible for the procedures.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] OK perfect uh hold on.
[CUSTOMER][NEUTRAL] OK, is there any other big important thing that I should know?
[AGENT][NEUTRAL] I mean, do you have any other questions you might
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alright, alright, so recap, it's a supplemental for the primary which in this case is Ahmed. It covers copays, coinsurance, deductible after primary, and the bill can be sent directly to you. It's not a reimbursement, so they first pay us and they you reimburse him.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It is a reimbursement. It is, it is a reimbursement, but also if I'm, I'm, I'm pretty sure that if the insured provides the, the information to you, he was hoping that you guys to submit the claim directly to us so he don't have to be.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Doing that after he received the treatment, right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so I'm not getting it. How, how is it?
[AGENT][NEUTRAL] Like I said, you can submit the claim. You, you can, you can submit the claim with us and also the insurance can submit the claim with us.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, OK, so both the insurance and us can send it.
[AGENT][NEUTRAL] So I
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I'm assuming that the insurer, if the insured provides the information to, to you, to the hospital, to the facility.
[AGENT][NEUTRAL] He was hoping for you
[AGENT][NEUTRAL] To do the job, right? To do the work.
[CUSTOMER][NEUTRAL] I guess right so.
[CUSTOMER][NEUTRAL] Back to the recap and the out of pocket maximum you said is 2500 of worth of procedures with the with which patient hasn't used correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, perfect. What what is your name again?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII] last name?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Correct. That's my name. Anything else I can do for you, just said.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, yeah, the, the last name, what is it?
[AGENT][NEUTRAL] The name of my last name is [PII]
[CUSTOMER][POSITIVE] Oh, also, oh, OK, thank you, thank you also.
[AGENT][NEUTRAL] Anything else I can do for you today?
[CUSTOMER][NEUTRAL] Alright, so the bill, the bill is sent just to confirm the last part, the bill is sent, correct?
[AGENT][NEUTRAL] To who?
[CUSTOMER][NEUTRAL] Do you
[AGENT][NEUTRAL] You sent the bills already?
[CUSTOMER][NEUTRAL] No, it first needs to be processed and then sent so.
[AGENT][NEUTRAL] Yeah, what do you have to do?
[CUSTOMER][NEUTRAL] Because I, I'm not.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah, sorry, go ahead.
[AGENT][NEUTRAL] What do you don't understand?
[AGENT][NEUTRAL] What is the part that you want to ask me?
[CUSTOMER][NEUTRAL] Yes, so, OK, I just want to be sure on this. He's got like 10 amount of co-pay worth of, uh, for with the premier insurance. He has to pay that to us and then he shows you the bill and you reimburse him, or we send the bill worth of that X amount directly to you and he doesn't have to pay.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Like I said,
[AGENT][NEUTRAL] Either or it's fine. The insured can submit the claim.
[CUSTOMER][NEUTRAL] Either or is fine.
[AGENT][NEUTRAL] And also the facility can submit the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you I just wanted to confirm that one.
[CUSTOMER][NEUTRAL] And date of effective date is [PII], right?
[AGENT][NEUTRAL] Let me double check with him.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] That is correct. [PII] is the effective date of the policy and is currently active.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect thank you very much sir you have a good day.
[AGENT][POSITIVE] Thank you for calling APM. You have a good day as well.
[CUSTOMER][POSITIVE] Thank you have a good day.