AccountId: 011433970860
ContactId: cc196b47-1ba2-4730-a5f4-1d5b8e156af1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294959 ms
Total Talk Time (AGENT): 139216 ms
Total Talk Time (CUSTOMER): 79644 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/cc196b47-1ba2-4730-a5f4-1d5b8e156af1_20250407T18:34_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Atlanta OB and CYN. We're just calling to get a patient's benefit.
[CUSTOMER][NEUTRAL] And see if we're in networking.
[AGENT][NEUTRAL] Um, yes,
[AGENT][POSITIVE] OK. Yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] It's gonna be [PII] and then a good callback number will be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] So the policy is gonna be 02452590 then M and then L 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] So it's gonna be [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] 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]. The policy is still active. And is this for outpatient benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hello. OK, for outpatient? OK. Under this policy, for outpatient, we cover up to $750 per day and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And um since this is secondary gap insurance, there's no authorization required because we go by the primary insurance guidelines.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so they're gonna go by the primary. OK, are we in network with this um insurance company?
[AGENT][NEUTRAL] Um, there is no network again, we go by the primary carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm. So do you understand? Yes, ma'am.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, um, is this benefits for a specialist office?
[AGENT][NEUTRAL] Um, these are benefits for outpatient services and outpatient facilities, but for services provided in the doctor's office, we do cover up to $750 a day also, but that's for the co-insurance and the deductible, the co-pay for office visits, including specialist office visits are is not covered.
[CUSTOMER][NEUTRAL] OK, so it's not covered but it's billed by the insurance.
[AGENT][NEUTRAL] Right. Well, normally what happens is that the uh the provider will be the primary insurance company first. And once you receive the explanation of benefits from the primary insurance company, you'll bill us for the co-insurance and the deductible. You'll send us the EOB along with the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is the annual deductible for this um.
[CUSTOMER][NEUTRAL] Insurance.
[AGENT][NEUTRAL] OK, let's see if there's a deductible under this policy. One moment.
[AGENT][NEUTRAL] OK, there's no deductible under this policy.
[CUSTOMER][NEUTRAL] Is there a out of pocket for this insurance?
[AGENT][NEUTRAL] Um, no, ma'am. Since we're secondary insurance, we cover the out of pocket for the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have your name?
[AGENT][NEUTRAL] Um yes, my name is [PII] [PII]. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, can I have a call reference number?
[AGENT][NEUTRAL] Um, for the reference number, you can use my name and today's date.
[CUSTOMER][NEUTRAL] So that would be EV.m or is it comma M or nothing in between?
[AGENT][NEUTRAL] Yeah, just nothing in between, just EVM and today's date.
[CUSTOMER][NEUTRAL] And that'll be 2 digit month, 2 digit day, and then 4 digit year?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Well, I thank you again for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.