AccountId: 011433970860
ContactId: ccce4a54-5f07-47ed-9aec-725d06a6906a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228020 ms
Total Talk Time (AGENT): 64063 ms
Total Talk Time (CUSTOMER): 146981 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/ccce4a54-5f07-47ed-9aec-725d06a6906a_20250424T18:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], sorry my voice disappeared. Hi [PII], my name is [PII]. um, I was just calling because I wanted to just kind of verify some information about um.
[CUSTOMER][NEUTRAL] I'm calling from a provider's office. I'm trying to verify about this plan here that this patient has. It, um, the APL was presented as like a secondary or supplement, uh, and I just wasn't sure how it would apply to professional claims if at all. I don't know if you could help me with that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[CUSTOMER][NEUTRAL] 6070.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Sorry, it is.
[CUSTOMER][NEUTRAL] 02456452
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Birth date is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I do show for her outpatient the per day maximum is $500 so that means we would pay her um outpatient, patient responsibility, which includes any co-pay deductibles or co-insurance up to that $500 maximum per day, and we do.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Pay um
[AGENT][NEUTRAL] We actually pay whoever um files first. So if you file first and there's an assignment of benefits, then the, the payment will come directly to your office.
[CUSTOMER][NEUTRAL] OK, OK, and so that applies for because it said outpatient, so that's typically still an institutional and that would apply as a so we should put it on as a secondary even to um.
[CUSTOMER][NEUTRAL] Professional claims, so like I work for an ophthalmologist. I don't think this person is actually coming in for any kind of surgery or anything like that. She's just coming in for an exam for for now for what I know we do have a primary um coverage like a major medical if you will, and then this was given as a supplement.
[CUSTOMER][NEUTRAL] Uh, and that's why I said like without because I did see when I was listening to the IVR, one of the options was Medin and Gap, and one of the options was um hospital indemnity and so of course I know that that has to do with more institutional so um if when this patient comes in because this is sort of um verifying ahead of time she wanted to make sure that we participated with both plans.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, we would obviously bill the EBMS first and then we should even with professional claims bill out the secondary or APL as the secondary.
[AGENT][NEUTRAL] That's correct. Uh, that's after you receive the EOB from the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct, yes, yes, with the coordination of benefits, correct. I just didn't know if it even applied for professional claims because sometimes they don't sometimes like with the gap or whatever they wanna call it, they only apply to institutional which would not be us, um, and so very good I appreciate that. I'll make sure to put it in as a secondary and let them process uh according to coordination of benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and that's actually all I have.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well thank you for choosing APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm bye bye.