AccountId: 011433970860
ContactId: c9ce9bbe-bcec-498b-9ede-d1d67988e995
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204679 ms
Total Talk Time (AGENT): 108967 ms
Total Talk Time (CUSTOMER): 83291 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/c9ce9bbe-bcec-498b-9ede-d1d67988e995_20250317T18:43_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there. My name is [PII]. I'm calling from Houston Methodist Sugarland Hospital. I need some assistance here, please. I'm showing this um insurance listed as a secondary. Primary listed for patient is United Health Care. Patient scheduled this week on Friday for um a procedure.
[AGENT][NEUTRAL] Um, sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] Thank you. Um, now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure. The number I have is listed as 01194612.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. I'm gonna spell the last name. [PII], [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Outpatient procedure.
[AGENT][NEUTRAL] OK. For outpatient, we cover up to $500 per occurrence and it's taking place in an outpatient facility, right?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Is it taking place? Is the surgery taking place in an outpatient facility?
[CUSTOMER][POSITIVE] Yes, my dear, yes, I'm so sorry. Yes, yes, outpatient hospital, yes.
[AGENT][NEUTRAL] OK. So we cover up to $500 per occurrence. So every 90 days, we'll cover up to $500 for um services, outpatient services. We cover up to $500 for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK, after primary process delay.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, so what type of um insurance or policy this one is, uh, my dear?
[AGENT][NEUTRAL] It's secondary gap insurance.
[CUSTOMER][NEUTRAL] Secondary gap, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right, so the claim has to go through and then you guys pick up or something like that, correct?
[AGENT][NEUTRAL] Yeah, what normally happens is that the provider files the claim with the primary insurance first and then once you receive the explanation of benefits, you'll file the claim with us and send the explanation of benefits from the primary insurance along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right and um question any prior authorization needed for you guys?
[AGENT][NEUTRAL] Um, no, ma'am. Since we're secondary gap, we go by the primary carrier's guidelines.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much. And I'm so sorry. Can I get your name again?
[AGENT][NEUTRAL] Yes, my name is [PII]. Um it's spelled [PII] and my last initial is [PII] and the reference number is my name and today's date. Is there anything else?
[CUSTOMER][NEUTRAL] To the date.
[CUSTOMER][POSITIVE] No, my dear, that's it. I thank you for your time.
[AGENT][NEUTRAL] But I can
[AGENT][POSITIVE] OK, thank you, [PII], for calling ATL. You have a great day. You're welcome.
[CUSTOMER][POSITIVE] Thank you. Take care. You too. Bye-bye.
[AGENT][NEUTRAL] Mm bye.