AccountId: 011433970860
ContactId: c1b3629c-87ea-4d99-939e-9a3249951b0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246360 ms
Total Talk Time (AGENT): 131497 ms
Total Talk Time (CUSTOMER): 92224 ms
Interruptions: 0
Overall Sentiment: AGENT=3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/c1b3629c-87ea-4d99-939e-9a3249951b0c_20250114T20:59_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] with Houston Methodist West.
[CUSTOMER][NEUTRAL] I um was reaching out to get some additional information on a patient's um gap coverage that she has with you guys.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, yeah, I'd love to help you um with some coverage details today, [PII]. Do you mind if I get a good callback number?
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][POSITIVE] Wonderful and your member's policy number?
[CUSTOMER][NEUTRAL] Uh, the member's policy number is 02580148.
[AGENT][POSITIVE] Perfect, and give me just a moment to get her policy pulled up, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], would you be able to verify for me please your member's uh first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Perfect. I see her right here. She's current and active with us. And what information is there that I can help you with today?
[CUSTOMER][NEUTRAL] So she is actually coming in for surgery tomorrow. Um, she did just let us know of this gap coverage today. And so, to be quite honest, I haven't, uh, either, uh, you know, processed anything with you guys or um honestly haven't heard of this this type of policy. So I was trying to see how um if we're able to bill y'all for the um portion that her primary isn't covering or how that would work.
[AGENT][POSITIVE] Yeah, absolutely, so, um.
[AGENT][NEUTRAL] So she does have um our gap coverage, Ms. [PII] um and we are her secondary insurance. We try to pick up and pay on any uh thing applied to the co-pay, the co-insurance, or the deductible for major medical, for accident, injury, or sickness. We don't cover anything routine, um, but quite honestly, I don't think any surgery is like really considered routine. Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then as far as um.
[AGENT][NEUTRAL] Her benefits with us go. I do wanna let you know any benefit information I give you over the phone is just a verification of coverage and not a guarantee of payment. Um, she does have an outpatient if it's an outpatient surgery or is it inpatient? I'm sorry, I should have asked.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let me confirm, let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do show that it is outpatient.
[AGENT][POSITIVE] Outpatient perfect. She has an outpatient benefit um of up to $1000 per calendar year, um, and that is um a benefit to help offset the cost of things applied to her co-pay co-insurance or deductible for major medical and as far as um if you all have never billed with us we do need that a W-9ine form with your tax ID associated to it, um, along with your first claim after that we won't need a W-9ine form anymore and you'll be able to submit claims to us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, if you all as the providers submit the claim, we'll submit payment to you all, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that money would come back to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] All right, um, I think that answers everything I needed to know um do you happen to have a call reference number?
[AGENT][NEUTRAL] Yeah, the call reference number is my name. Um, it's [PII] in today's date.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Alright, well think mhm.
[AGENT][POSITIVE] Oh, I was just gonna say if you have any other questions you run into along the way or um always feel free to reach out to us we'll do our best to help you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sounds perfect. Thank you so much, [PII], for all your help.
[AGENT][POSITIVE] Oh, it's my pleasure. Thank you so much for calling APL and you have a fabulous day, [PII].
[CUSTOMER][POSITIVE] Thank you so much, you as well.
[AGENT][POSITIVE] Thanks. Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.