AccountId: 011433970860
ContactId: b9a20978-3658-477e-9651-cbd5268219e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279660 ms
Total Talk Time (AGENT): 157366 ms
Total Talk Time (CUSTOMER): 92198 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/b9a20978-3658-477e-9651-cbd5268219e9_20250220T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Good morning. um, I'm calling from Palmetto Lake Surgical Center and I wanted to verify benefits on uh on a patient.
[AGENT][POSITIVE] Yes, ma'am. I will be glad to help you. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Um, the policy number is 02565547.
[AGENT][NEUTRAL] All right, [PII], thank you for that information. Now, while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all that information. Now, your patient's name and date of birth today.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] That looks like [PII] is the insured on this medical supplemental plan. They show the original effective date is [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want to verify benefits or just checking eligibility today.
[CUSTOMER][NEUTRAL] No, well, benefits. I'm calling from an ambulatory surgical center. Uh, his, uh, primary insurance is UnitedHealthcare, and it has a $5000 deductible.
[CUSTOMER][NEUTRAL] Um, I wanted to know if this.
[CUSTOMER][NEUTRAL] uh, you know, covers, yeah.
[AGENT][NEUTRAL] Be. OK. All right. So outpatient surgery, uh, let's see.
[AGENT][NEUTRAL] Give me just a moment. My computer is moving slow so bear with me this morning, right?
[CUSTOMER][NEGATIVE] Yeah, my computer, it's uh my software is not working, that's why I'm calling.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Alrighty. OK, let's see the benefit. And of course, we are just a medical supplemental plan. So the only thing that we would pick up and pay on is anything for sickness and injury, nothing routine here is covered no matter what. Excuse me.
[AGENT][NEUTRAL] And it has to apply.
[CUSTOMER][NEUTRAL] OK, so you only cover accidents?
[AGENT][NEUTRAL] Accidents and sickness. Yes, ma'am, and it has to apply towards patients deductible, co-pay or co-insurance at their primary in order for us to pick anything up. Now, the benefit here, let's see for outpatient.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me pull that.
[AGENT][NEUTRAL] Looks like they have an outpatient max benefit of $6000 payable per calendar year.
[AGENT][NEGATIVE] No deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, but the, the, the first insurance or the primary insurance, uh, has a $5000 deductible that has not been met. You guys don't pick up that, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If it applies towards that deductible at the primary, that is what we would pick up and pay for sickness and injury only, but yes ma'am, it has to apply towards their deductible co-insurance or co-pay at their primary. So what you would do was, was what we'll be to send the original claim a copy of that along with the EOB from the primary so we can coordinate any benefits that might be available.
[CUSTOMER][NEUTRAL] I see, so we, we bill United and then if United doesn't pay anything we bill you and you, you pay up to 6000.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so I don't, I should not charge the patient up front yet as of yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, is that all that I can help you with?
[CUSTOMER][NEUTRAL] Yeah, may I have a reference number?
[AGENT][NEUTRAL] We do not give reference numbers, but you can use my name in today's date, [PII]. It is spelled [PII] My name is [PII].
[CUSTOMER][NEUTRAL] And today's day it's OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] Yes, ma'am, and thank you for calling APM. You have a great rest of your day, OK?
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.