AccountId: 011433970860
ContactId: b05fba6f-2f3c-4736-896b-901b14a42079
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 606119 ms
Total Talk Time (AGENT): 221748 ms
Total Talk Time (CUSTOMER): 406041 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/b05fba6f-2f3c-4736-896b-901b14a42079_20250410T15:44_UTC.wav
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[CUSTOMER][NEUTRAL] American
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi your name is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Is that what you said [PII]? OK, hi [PII], my name is [PII]. My name is [PII]. Hi, and I was wondering, I'm, I just was calling to verify um what type of insurance this is because uh we have a patient that presented this card as a secondary, and I just kinda wanna know how this plan would pay um what do you need from me first?
[AGENT][NEUTRAL] Yes, ma'am. Hi.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Miss [PII], first, can I get your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, sure, my direct line is [PII].
[CUSTOMER][NEUTRAL] And that's a direct line.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, it's [PII]. Date of birth is [PII], and the policy number is 02350220.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK, uh huh.
[AGENT][NEUTRAL] OK, I do show that [PII]'s policy is active. Um, the effective date of the policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you are correct, this is a supplemental insurance policy. It is billed secondary to the primary, and it does help with deductible, co-pay and co-insurance, and this is just to verify that if it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, you know what, I don't know you're cutting, it's like.
[AGENT][NEUTRAL] She
[CUSTOMER][NEUTRAL] You're you're cutting out really bad right now. I'm sorry let me see, keep talking, maybe it's better now yeah yeah oh it was good until you started giving me all the information I'm like oh OK go ahead.
[AGENT][POSITIVE] Oh, I'm so sorry, Ms [PII].
[AGENT][NEUTRAL] Yes, thank you, but it does.
[AGENT][NEUTRAL] Oh, sorry. OK, so it does help with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how does it work? OK.
[AGENT][NEUTRAL] Uh, she has an in.
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $3500.
[AGENT][NEUTRAL] And then she also has an outpatient calendar year benefit amount of $3500 to go towards deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so she's gonna be having outpatient surgery. OK, so you're saying that's the benefit for outpatient surgery, it's $3500?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that what you said, the benefits?
[AGENT][NEUTRAL] To help
[AGENT][NEUTRAL] Yes, to help with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] So that's to help with her primary co-pay to help with that so they give her, they give her this, this, this 3500 she gets and she uses it towards her primary benefits is that what you for outpatient surgery? OK, so, OK, so she gets that because she's asking us, she wants to know what her.
[AGENT][NEUTRAL] Right. Yes.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What her cost is gonna be her deductible, what her, she's interested in what her deductible and co-pay amounts for the primary and the secondary insurance are going to be. So that's why I'm trying to see from you guys how this is gonna come in on the secondary. So you're saying you give the patient $3500 to go towards her her.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] To go to her deductible and her primary right to go towards the primary deductible, right? OK.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Deductible and uh OK and then is that it just a 30 it's just a flat 3500 she gets OK mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. Um, and once that's used for the calendar year, you know, the benefit is exhausted. But she does have, um, in her policy, it does state that a covered outpatient facility.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is a freestanding outpatient surgery center. Is that what you guys are?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's exactly well we're the doctor, but we would be scheduling her there we would be scheduling her at our facility which is an ambulatory surgery and they do have that benefit for that is what you're saying? It does cover it or it does not. It does. OK, so this will cover it, so this will.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] It does. It is on her policy.
[CUSTOMER][NEUTRAL] Cover an ASC, OK, ambulatory surgery center. So this goes towards that as well as the hospital, but we're putting her at our surgery center. Anything outpatient, right, is what you're saying, a facility.
[AGENT][NEUTRAL] Right. Would be a, um, for her surgery would be an outpatient surgery center, hospital emergency room, hospital outpatient facility, MRI facility.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Surgery center, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all that.
[AGENT][NEUTRAL] Yeah, or urgent care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this is what she gets and that's all that's what you give her period that's so has she used that? Has she used it yet?
[AGENT][NEUTRAL] Let me check, let me look and see if she has anything remaining.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For and it's for the calendar year?
[AGENT][NEUTRAL] Yes, ma'am, per calendar year.
[CUSTOMER][POSITIVE] She gets it OK.
[AGENT][NEUTRAL] OK, so she has used $1,683.53.
[CUSTOMER][NEUTRAL] $1,608 is that what you said?
[AGENT][NEUTRAL] $683.53.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] 0 10683.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 1683, right?
[AGENT][NEUTRAL] 1000, yeah, 1683 53. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, 16
[CUSTOMER][NEUTRAL] 53. OK, great, that's what she's used, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So that's been used, OK.
[CUSTOMER][NEUTRAL] Has been.
[CUSTOMER][NEUTRAL] Used so she would so subtract that from the 35 that's what she's got to help her out with her primary, right?
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, has been used, OK.
[CUSTOMER][NEUTRAL] And then once that exhausts, that's all she gets for the year, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I'm just making my notes per calendar year and then this will cover has been used and OK and then we don't need to worry about how about pre preauthor anything like that does that apply to you guys we need to do get a pre off precert or author anything? OK, no.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No ma'am, this isn't the primary so it's not required.
[CUSTOMER][NEUTRAL] Good, no pre-cert because a lot of times you just never know. So I will put that also, and this is called American Public Life, is that what it is? It says it on the card, right? OK, Prey, OK.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes ma'am, yeah.
[AGENT][NEUTRAL] Yes, and you can you can uh abbreviate it with APL.
[CUSTOMER][NEUTRAL] Right, APL, OK, I, you know, I'm gonna make sure because it looks like somebody loaded up. I wanna make sure we have the right address in here because we would still still bill to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you'll send in a claim, right, yes, you'll send in a claim, um, and we'll need the primary EOB sent with the claim.
[CUSTOMER][NEUTRAL] Would we still bill or OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To show what the primary paid, let me give you our payer ID number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because we don't have, I have PO Box 9738 in [PII], is that right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Let me see what we have on the card. See, I think they let me see because I'm sure they just grabbed what we had because it should be [PII]. I'm trying to read the back of the damn card it keeps popping away [PII]. That's what it should be, right? 248-950 [PII], Oklahoma. OK, so that's what it should be and then is the payer.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yes, that
[AGENT][POSITIVE] You're correct.
[CUSTOMER][NEUTRAL] I don't see if I see the the payer ID on here. What is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's the payer ID.
[CUSTOMER][NEUTRAL] And it would be under Ame OK, it looks like we don't, I don't know if we have that under American, yeah, I don't know what that is. Maybe that's did it used to be that I don't know American public because that's what we had.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Yeah, I don't know where that came from. [PII]. I don't know. American Public Life, very odd. Oh, but you know what? I think I do have it. We have it loaded as American Public Life supplement, which would be OK. 24895 [PII]. Yep, we do have it. They just grabbed the wrong 1. 248. Yep, we do have it. OK.
[AGENT][POSITIVE] Oh, good.
[CUSTOMER][NEUTRAL] Yeah, we just had it. There was something else in there too, so I do have that corrected. So we've got that and then I think that's all I needed. We've got the ID number in there. Oh, they did put a group number of 19253 and yeah, so 7 OK yeah looks like that's what's on the card 19253, OK.
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I think that's all I needed for now um I'm gonna, can I have a reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good thank you so much you have a great rest of your day.
[AGENT][NEUTRAL] You too, Miss [PII] is that all I can help you with before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that's it thank you.
[AGENT][POSITIVE] OK, well thank you for calling APL and you take care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.