AccountId: 011433970860
ContactId: ca193277-6fc4-436a-ab9e-94c67b40d9b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391690 ms
Total Talk Time (AGENT): 166797 ms
Total Talk Time (CUSTOMER): 172230 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ca193277-6fc4-436a-ab9e-94c67b40d9b4_20250108T17:56_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII], um, from University of Io Healthcare just calling to verify eligibility and benefits for a patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'd love to help you with some eligibility and benefits today, Ms. [PII], and may I have real quick a good call back number for you?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much and.
[AGENT][NEUTRAL] What is that member's policy number?
[CUSTOMER][NEUTRAL] I have a 01849104.
[AGENT][NEUTRAL] 49104 you said?
[CUSTOMER][NEUTRAL] 491 yep 01849104.
[AGENT][POSITIVE] Perfect and let me get this person pulled up for you.
[AGENT][NEUTRAL] All [PII]. And would you be able to please verify for me your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yep, [PII] goes by [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. Your patient is current and active with an effective date of [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] You said you're wanting benefits inpatient or outpatient today?
[CUSTOMER][NEUTRAL] Um, it'll be out, I guess.
[CUSTOMER][NEUTRAL] So I'm this isn't added to his file yet. I just kinda have to verify what type of plan it is and then I can give you what benefits I need.
[AGENT][NEUTRAL] Oh, we are his secondary supplemental plan.
[CUSTOMER][POSITIVE] Secondary, that is perfect.
[CUSTOMER][NEUTRAL] This Sunday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is is it kind of like a limited benefit plan or?
[AGENT][NEUTRAL] Kind of like a gap insurance.
[CUSTOMER][POSITIVE] OK, gap insurance perfect.
[CUSTOMER][NEUTRAL] So is it just one of those that just kind of covers the.
[CUSTOMER][NEUTRAL] Whatever is not covered by primary type plans OK.
[AGENT][NEUTRAL] Yeah, it's the copay, coinsurance, your deductible as long as it's within the realms of the policy.
[CUSTOMER][POSITIVE] Perfect. OK, so then let me.
[CUSTOMER][NEUTRAL] Just gonna go with my limited note here um what networks used to process facility and physician charges?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I know some of this might not really technically apply um.
[AGENT][NEUTRAL] Yeah, so I guess we just follow whatever their major medical uses.
[CUSTOMER][NEUTRAL] Follow primary
[AGENT][NEUTRAL] Um, yes, um.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] That is all right and then um so no, I just kinda have to run through these questions um are there any limitations at all like say outpatient visits inpatient stays, lab and radiology?
[AGENT][NEUTRAL] There isn't like visit limits but there's like um a coverage limit so they have like if they're outpatient they have up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient of.
[AGENT][NEUTRAL] Um, and I can give you their inpatient one as well. I do also wanna just let you know that any benefit information I give you today is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, so outpatient up to 2000 a year, um.
[AGENT][NEUTRAL] Mhm and then inpatient is up to $4000 per calendar year.
[CUSTOMER][NEUTRAL] 124.
[CUSTOMER][NEUTRAL] $10 per year, no accumulations yet.
[AGENT][NEUTRAL] Um, not that I've seen, but I can double check.
[CUSTOMER][NEUTRAL] Not sure if you um
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] No limit.
[AGENT][NEUTRAL] I'm not showing anything for 2025. Sorry, I just.
[CUSTOMER][NEUTRAL] And then you said so this
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] No, you're good you're good. OK, and then you said, um, so this plan covers co-pays, co-insurance. What was all of it for it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the deductible, yes.
[CUSTOMER][NEUTRAL] Cover
[AGENT][NEUTRAL] And then I did want to let you know you had briefly mentioned this um most of our policies do not cover like the administrative fees they might cover like treatment performed in an office setting, but they're not gonna cover like maybe the facility or physician's fees um and I wouldn't know for sure until it comes through on a claim form, but I did just want to give you a heads up.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, mm may not cover administrative fees.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh perfect and.
[CUSTOMER][NEUTRAL] Uh, [PII], is he considered the subscriber?
[AGENT][NEUTRAL] Yes, he is.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Group number
[AGENT][POSITIVE] Oh, let me pull that up for you real fast.
[AGENT][NEUTRAL] Group number is 24032.
[CUSTOMER][NEUTRAL] Claims mailing address
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Can I have you repeat that just one more time just to make sure I got it right.
[AGENT][NEUTRAL] No worries. [PII].
[AGENT][NEUTRAL] We also have an electronic payer ID if that makes things easier for you.
[CUSTOMER][NEUTRAL] I can take that as well.
[AGENT][NEUTRAL] You bet you it's 60801.
[CUSTOMER][NEUTRAL] OK perfect and then I think that should be it um I guess last thing um if our facility is the one to submit claims to you guys after that primary um would our facility receive that reimbursement back?
[AGENT][NEUTRAL] Yes, if you submit the claim, we'll send the payment to you and if the insured submits the claim, we send it to them.
[CUSTOMER][POSITIVE] Perfect. OK, awesome. That should be all that I need. Do you have a call reference number by chance?
[AGENT][NEUTRAL] Yes, one second.
[AGENT][NEUTRAL] So sorry, I had to sneeze. Um yes, my call reference number is my name, [PII], first initial last name, B like boy, and today's date.
[CUSTOMER][POSITIVE] Awesome, thank you so much for looking all that up for me kind of explaining everything makes it a lot easier.
[AGENT][POSITIVE] Yeah, I'm glad I could help you today. And then is there anything else I can do for you, Miss [PII]?
[CUSTOMER][POSITIVE] That should be it, thank you so much.
[AGENT][POSITIVE] Perfect, yeah, it's my pleasure. Thank you for calling APL you have such a fabulous day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.