AccountId: 011433970860
ContactId: b4fbe7b6-1f05-437c-8e74-34bf745443de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192320 ms
Total Talk Time (AGENT): 93533 ms
Total Talk Time (CUSTOMER): 91023 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/b4fbe7b6-1f05-437c-8e74-34bf745443de_20250613T14:49_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name's [PII] calling with Houston Methodist, the Woodlands Hospital. Um, I need to verify, um, eligibility for, uh, [PII] on this plan and then also check, uh, for authorization requirements.
[AGENT][NEUTRAL] Sure, I can check eligibility and see if authorization is required. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Uh huh, yeah, my direct line is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is 02517074 M Mike Lima the number 8.
[AGENT][NEUTRAL] OK, thank you and then uh do you have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh huh, [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. OK, so this policy is active.
[AGENT][NEUTRAL] Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays and as uh this policy is very dependent on uh their major medical as long as they're willing to pay this policy can so no authorization is required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No author required OK and then do you guys like reimburse the the member directly or is it a claim that the facility has to file?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, either one, so if the facility were the ones to file the claim, we would send that payment to them. If the member were to file the claim, we would send the payment to them.
[CUSTOMER][NEUTRAL] OK, OK, perfect. So, um, so is, is it just I guess more or less just like a traditional like supplemental policy?
[AGENT][NEUTRAL] More or less, um, secondary medical but it it is considered supplemental.
[CUSTOMER][NEUTRAL] Or no.
[AGENT][NEUTRAL] It just, it follows major medical, um, so again, like if they're not willing to pay this policy can't. That's pretty much the general rule of thumb. It helps supplement what major medical pays.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, perfect, all right, and so we can either file or the member can file um um for reimbursement and then you said no off required.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, Ms. [PII], I think that you know what, hold on, let me make sure that I have a um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII] mailing address I don't think we have a copy of her card. OK, no, I think we do. So is it [PII] like claims mailing address?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, I've also got a fax number and a payer ID I can give you if you need that.
[CUSTOMER][NEUTRAL] Uh, no, that's OK. I think, I think we're good, um, all right, Ms. [PII], will there be any, um, call reference number for us?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, it would just be my first name, last initial, and today's date, and so my name is spelled [PII] and there wasn't anything else I could help you with, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it. I appreciate your help thank you so much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling ATL. Have a great rest of your day.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][POSITIVE] Thank you bye bye