AccountId: 011433970860
ContactId: c48ee432-9342-434a-9bd1-a4e09470bff1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202869 ms
Total Talk Time (AGENT): 85929 ms
Total Talk Time (CUSTOMER): 108578 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/c48ee432-9342-434a-9bd1-a4e09470bff1_20250417T18:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's uh [PII]. I'm calling from Doctor [PII]'s office, and I need to find out benefits.
[AGENT][POSITIVE] OK, yeah, I can check benefits for you. uh [PII], can I get a good call back number for you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][POSITIVE] I have here policy coverage group insured effective.
[CUSTOMER][NEUTRAL] I'm reading the card hold on APL insured coverage.
[AGENT][NEUTRAL] Oh sure, so on the card, do you see where it says uh in hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] Uh, yes, at the end, yes, I do see.
[AGENT][NEUTRAL] OK, yeah, either one of those, please.
[CUSTOMER][NEUTRAL] Uh, OK, uh, uh, patient benefit 01935546 ML 8.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. So this policy is active. Effective date was [PII], 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 of course I will let you know verification of coverage is not a guarantee of payment for claims and this was outpatient, correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, it's gonna be for a colonoscopy performing an outpatient. Uh, we're not participating with any insurance, but, uh, primary insurance apparently it's an EPO which does not have a network so how, how can patient go about it? She would have to send it to you showing that no coverage and as a secondary you'll help her or no?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] No, so.
[AGENT][NEUTRAL] No, so this policy will not pay anything unless the primary does. The primary has to uh contribute for this policy to be able to.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] To be able to, OK, I'll let the patient know. So this, yeah, so the center for the colonoscopy, they are in network, so she'll be fine with them being a secondary and them being in network uh authorizations, do I go through you or through the primary and you honor it? No? OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It through primary, yes, absolutely. This policy is just very dependent on whoever she has as her primary.
[CUSTOMER][POSITIVE] Uh perfect.
[CUSTOMER][NEUTRAL] Got you. Oh, that makes sense. OK, let me just make a note here secondary APL.
[CUSTOMER][NEUTRAL] I just need your name and a reference number. I'm good to go.
[AGENT][NEUTRAL] Sure, uh, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial is [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, you got it, [PII], thank you, appreciate that.
[AGENT][POSITIVE] Alright, yeah, thanks for calling ATO have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.