AccountId: 011433970860
ContactId: b59f0c86-5c0e-4a62-86e1-4800c504894a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417589 ms
Total Talk Time (AGENT): 210426 ms
Total Talk Time (CUSTOMER): 138039 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/b59f0c86-5c0e-4a62-86e1-4800c504894a_20250430T13:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling. I, uh, I have an appointment with my orthopedics on Friday, and they were asking me to fill out the secondary insurance form, and I don't have to see your name on it. Can you tell me what, uh, what should I use?
[CUSTOMER][NEUTRAL] As an insurance carrier.
[AGENT][NEUTRAL] Wait a minute. The, so the, the, the doctor is asking you to fill out a form for your secondary insurance, but you don't see APL.
[CUSTOMER][NEUTRAL] No, I don't see APL is what I'm asking. um, this is the this is what um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The form was uh Bes health.
[AGENT][NEUTRAL] Right, so the reason I'm hesitating and trying to figure it out is because I don't know what form the provider will help you with their forms. I don't know what they're giving you. Typically, all you have to do is give them your policy number and our phone number and they will call us to verify benefits. So I don't know what they gave you.
[AGENT][NEUTRAL] Is it the
[CUSTOMER][NEUTRAL] OK. Do you, do you cover, do, do you cover the doctors at the Baptist Health?
[AGENT][NEUTRAL] I can pull up your policy and see what your benefits are.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] You want to do that? OK. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, and then your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] Uh, my policy number. Um, I have a payroll.
[AGENT][NEUTRAL] Do you have your ID card with you?
[CUSTOMER][NEUTRAL] It it has a payer ID is that what you're asking?
[AGENT][NEUTRAL] No, ma'am, do you have your ID card with you? I'm gonna tell you what to look for.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Alright, so you're looking for the in-hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Yeah, in front of me.
[AGENT][NEUTRAL] It should start with the
[CUSTOMER][NEUTRAL] Yeah, which one do you want?
[AGENT][NEUTRAL] It's the same numbers. I just need those numbers.
[CUSTOMER][NEUTRAL] 024787.
[CUSTOMER][NEUTRAL] 15 ML 7.
[AGENT][NEUTRAL] OK, hold on one moment. Alright, and I have you here, and Ms. [PII], can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Uh [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so the
[AGENT][NEUTRAL] [PII] is outpatient. So for outpatient, your policy will pay up to $300 per calendar day. So each day you have $300 that you can use towards expenses. Now, if it's an office visit, like the doctor's office, your secondary policy doesn't have any coverage for the office setting. It's for inpatient, like if you're admitted to the hospital.
[AGENT][NEUTRAL] And then outpatient, so like the urgent care emergency room, any outpatient surgeries, diagnostic testing.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, how do I know this is an outpatient setting or not? They gave me a address.
[AGENT][NEUTRAL] Because the only, the only options are outpatient or inpatient unless you're admitted into the hospital, which is inpatient, it is considered outpatient.
[CUSTOMER][NEUTRAL] If you, if I'm being admitted to the hospital, but I'm not admitted to the hospital.
[AGENT][NEUTRAL] Right, so your question was how do I know the difference between inpatient and outpatient? The answer is inpatient is when you're admitted into the hospital. Everything else is outpatient.
[AGENT][NEUTRAL] So if you're not admitted to the hospital as an outpatient.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, yeah, I know it's outpatient, but I'm talking about this location is it considered as outpatient?
[AGENT][NEUTRAL] The location doesn't matter. If you're not admitted into the hospital, it's outpatient.
[AGENT][NEUTRAL] Or the doctor's office.
[CUSTOMER][NEUTRAL] OK. Uh, does that cover or no?
[AGENT][NEUTRAL] Is it a doctor's office or is it a like a urgent care or outpatient facility? If it's a doctor's office, there's no coverage on your policy.
[CUSTOMER][NEUTRAL] Um, it tells me it is a, uh,
[CUSTOMER][NEUTRAL] It's at a um a doctor's hospital.
[AGENT][NEUTRAL] So it sounds like it's an outpatient hospital facility. So if that's the case, then yes, you do have coverage for an outpatient hospital facility. The the best thing to do.
[CUSTOMER][NEUTRAL] I, I have the address. Can you confirm that?
[AGENT][NEGATIVE] No, ma'am. The address does not help us.
[CUSTOMER][NEUTRAL] I have the
[CUSTOMER][NEUTRAL] It doesn't help you, OK. The doctors.
[AGENT][NEUTRAL] The only way to answer your question.
[CUSTOMER][NEUTRAL] The, I have the doctor's name, I have the address, and
[CUSTOMER][NEGATIVE] That doesn't help?
[AGENT][NEUTRAL] No, because the the only two options are inpatient and outpatient. So are you being admitted to the hospital?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So it's outpatient.
[CUSTOMER][NEUTRAL] It's outpatient, and if it's only if it is inside a hospital.
[AGENT][NEUTRAL] If you are, if you go to the hospital and they admit you and put you in a room that's inpatient. Anything else?
[CUSTOMER][NEUTRAL] I understand that.
[CUSTOMER][NEUTRAL] Yes, anything else is outpatient, but you cannot tell me whether this is covered as an office visit or as an outpatient.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, I can't because it, it depends on the coding that they, it depends on what you're getting done.
[AGENT][NEUTRAL] Which would, which would generate codes and those codes would let us know. So the easiest thing for you to do is to give your doctor's office your ID card and tell them to call us to verify benefits so that you don't have to do all of this and they can ask the correct questions to get the answer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what about the urgent med? Does it considered as outpatient?
[AGENT][NEUTRAL] Urgent care, yes, it's outpatient.
[CUSTOMER][NEUTRAL] Urgent care is outpatient. All urgent care.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, alright, I'll just do what you said then thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you, bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.