AccountId: 011433970860
ContactId: cb8dfbed-673a-4b0e-9da5-cc588d2c97e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287609 ms
Total Talk Time (AGENT): 130770 ms
Total Talk Time (CUSTOMER): 71335 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/cb8dfbed-673a-4b0e-9da5-cc588d2c97e2_20250509T19:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], good afternoon. I'm calling because I have a patient of mine that's um here at the clinic waiting to be seen. Um, she's stating that she has gap insurance through a Mar Public Life. Um, I'm calling to verify the benefits as well as if you guys will cover her co-pay for her visiting.
[AGENT][POSITIVE] OK, um, I can definitely help you with the policy. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes. Uh my name is [PII] Contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, um 02.
[CUSTOMER][NEUTRAL] 206121
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. Hold on one second, I switch screens right in the middle, sorry.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Yes, it's been active since [PII], and this is the secondary policy, so we do apply towards the copay, deductible and co-insurance of covered charges after Florida Blue. Um, now, if you all require for the co-pay or the deductible to be paid to be seen, then she would need to make the payment and then on the back end,
[AGENT][NEUTRAL] Um, we could reimburse her or if something is still owed to you all after primary has applied, we can apply to you all as well. Um, are you considered outpatient? Well,
[CUSTOMER][NEUTRAL] OK, um, for the visit, it's considered, yes, um, outpatient office visit.
[AGENT][NEUTRAL] Let me double check this policy because it looks like the secondary only has coverage for inpatient. Um, let me double check. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No, not at all. Thank you.
[AGENT][NEUTRAL] OK, you're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So yes, the secondary policy only covers inpatient um expenses, so after the admission in the hospital. So for her secondary insurance, if it's outside of that, there wouldn't be any coverage.
[CUSTOMER][NEUTRAL] OK, um, she has the insurance through Cosby Shield, and you guys are considered their secondary insurance. In this case, since it's not an inpatient visit, she would need to pay the copay. You guys only cover inpatient expenses.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Well, she, even if it was something that we covered, she would still need to be, she would still need to pay upfront to be seen and then we handle it on the back and once the claim is processed, um, but because there's no in-office coverage or outpatient coverage, we wouldn't apply at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Again, I have your name and the call reference number.
[AGENT][NEUTRAL] Sure, my name is [PII]
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And no reference number, just your name?
[AGENT][NEUTRAL] And there's
[AGENT][NEUTRAL] Right, there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Take care.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.