AccountId: 011433970860
ContactId: d38e9de6-ffe4-457e-8474-ae8fc1a259b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212199 ms
Total Talk Time (AGENT): 90345 ms
Total Talk Time (CUSTOMER): 109903 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/d38e9de6-ffe4-457e-8474-ae8fc1a259b5_20250228T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with a chiropractor in [PII], and I'm calling to get benefits on one of your insured.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the benefits. Um, can you please give me the name of the facility and your callback number, please?
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Yes, it's Dr. [PII]
[CUSTOMER][NEUTRAL] And the number here is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] I have the name is [PII] Her date of birth is [PII] and it says, let me just get this for a second, it says uh uh coverage employee and child group and plan plan says med link select group med supplement.
[CUSTOMER][NEUTRAL] Group 19145.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you see an inpatient or an outpatient certification number?
[CUSTOMER][POSITIVE] Yes I do.
[AGENT][NEUTRAL] May I have one of those numbers?
[CUSTOMER][NEUTRAL] That is the
[CUSTOMER][NEUTRAL] Yes, 101,887,320 [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII], and this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay and co-insurance.
[CUSTOMER][POSITIVE] Good how are you doing?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $6600 and then she also has a calendar year benefit amount for outpatient of $6600.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, that covers the deductible. Now can I ask a question? I'm going to submit um the claims to Cigna, and they will of course deny it because it would be going toward the deductible. Does Cigna then forward it to you or do I have to wait for the denial and send it to you?
[AGENT][NEUTRAL] So the policy is based on what the primary pays if the primary um.
[AGENT][NEUTRAL] Yes, what, what you're asking is, yes, you will need the denial because you'll actually need the explanation of benefits from the primary insurance to send with the claim for.
[CUSTOMER][NEUTRAL] OK, so they won't, they don't forward it like it said, like Medicare folds it to a supplemental, so they don't do that. I would have to wait for the denial or the the EOB and send that EOB with the new claims to you guys.
[AGENT][NEUTRAL] This policy.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright, that was my question. Great, um, I think that's all I need, and I have your address as [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much I appreciate your help.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. You have a good weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you too thank you bye bye.
[AGENT][NEUTRAL] Hm. Bye-bye, ma'am.