AccountId: 011433970860
ContactId: c6241d87-14e4-4996-9929-a3f340a7d77d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408910 ms
Total Talk Time (AGENT): 156554 ms
Total Talk Time (CUSTOMER): 200041 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/c6241d87-14e4-4996-9929-a3f340a7d77d_20250319T16:54_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm at San Antonio Regional Hospital, and I'm calling to see if I can get benefits on a member that's coming into our facility for an outpatient procedure.
[AGENT][NEUTRAL] Yes, Ms. [PII], I can help you with benefits. Uh, can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It's [PII] [PII] and it is 02506865.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. His effective date is [PII], and this is just to verify his benefits. It's not a guarantee of payment. This is a supplemental insurance policy that is billed secondary to the primary.
[AGENT][POSITIVE] It has um benefits for um outpatient.
[AGENT][NEUTRAL] Of per occurrence of $500.
[AGENT][NEUTRAL] That helps towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so this pays up to $500 for any outpatient services whether it goes to the deductible or now how does it work? Is it something that he would pay up front and gets reimbursed from you or is it something that you cover automatically?
[AGENT][NEUTRAL] Uh, so what happens is, is it's based on what the primary insurance pays. So the, um, primary insurance will have to be billed first and then the EOB is sent from the primary insurance showing um what they paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] So that's how it works and then this kicks in after the primary pays their part for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so like if the patient owed $489 for this outpatient procedure, that's his 20% and that would be something you would pick up as his secondary.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so, um, what I don't, I didn't really know what the name of this insurance is.
[AGENT][NEUTRAL] It's American Public Life.
[AGENT][NEUTRAL] Is our company
[CUSTOMER][NEUTRAL] Oh, so it's a weird
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it um like what network is it from? do you know?
[AGENT][NEUTRAL] We're a standalone company um we don't have a network, especially for this ones because it's not the primary insurance so there's no network for it um it's a Medlink is the name of the plan type.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it something I guess what I'm trying to find out is it something that um we wouldn't code you as a secondary though because the insurance his insurance primary automatically knows to send it to you right?
[AGENT][NEUTRAL] No, the, um, no.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, they don't automatically know to send it to us.
[CUSTOMER][NEUTRAL] So I have to code you as a secondary then for it to go to you, correct? OK then I gotta figure out how I'm coding you, um, because let me see.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I don't have just a blank.
[CUSTOMER][NEUTRAL] Uh, let me see, trying to.
[AGENT][NEUTRAL] Now you can do it as a gap insurance if you wanted to do it that way.
[CUSTOMER][NEUTRAL] So I only have like like it's a miscellaneous Aetna [PII] Street, uh CCN Cigna First Health, those kind of that's what I have as.
[CUSTOMER][NEUTRAL] As an extra, you know what I mean?
[AGENT][NEUTRAL] Would it
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Would it help if I gave you the payer ID number where you could see.
[AGENT][NEUTRAL] Our company
[CUSTOMER][NEUTRAL] I don't know how to plug that into this. What about PHCS? does that sound familiar?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh what if I just do non-contracting? I'm just gonna put you under non-contracting.
[CUSTOMER][NEUTRAL] OK, so you call it, what did you call the insurance APL, but what does that stand for?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and what's the mailing address?
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] And that's in [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oops
[CUSTOMER][NEUTRAL] [PII] and then let's see, this is your number 256-8606. And then the policy number I gave you was the correct one, right? The 025.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, um, all right, sorry, I put a symbol in there and he didn't like that.
[CUSTOMER][NEUTRAL] Like, OK, hold on, I'm.
[AGENT][NEUTRAL] They are they are finicky, aren't they?
[CUSTOMER][NEUTRAL] Yeah, hold on, I'm getting it just a second. Now the group number I think he told me was, is it 1585 or was that the payer ID? I can't remember.
[AGENT][NEUTRAL] The group number is 15185.
[CUSTOMER][NEUTRAL] What's his
[CUSTOMER][POSITIVE] OK, perfect. That's what I have. OK. All right. So I'm gonna put you in this way. That way then.
[CUSTOMER][NEUTRAL] When Aetna pays or what's his primary, I said Aetna, but I don't think it's Aetna.
[CUSTOMER][NEUTRAL] Um, oh, it is Aetna, so when Aetna pays, then they'll automatically send this, the bill, the EOB to you after that.
[CUSTOMER][POSITIVE] I think it's how this will work.
[CUSTOMER][NEUTRAL] OK, alright, so then we won't collect anything up front now that I know and I'm sorry, can I get your, I got Tory, but can I get the first initial of your last name?
[AGENT][NEUTRAL] Yes, ma'am. It's A.
[CUSTOMER][NEUTRAL] OK, and how about a call reference number?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] Perfect. All right. All right. Well, thank you so much. I really appreciate your help.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Nope, that was it.
[AGENT][POSITIVE] OK, well, you have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.