AccountId: 011433970860
ContactId: d85adae8-2dac-4557-a7fa-b1d84322470f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234919 ms
Total Talk Time (AGENT): 109963 ms
Total Talk Time (CUSTOMER): 73768 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/d85adae8-2dac-4557-a7fa-b1d84322470f_20250424T13:06_UTC.wav
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[AGENT][NEUTRAL] Contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from Baptist Health Surgery Center. Um, I wanted to verify if a patient's, um, gap insurance is active and some coverage information.
[AGENT][POSITIVE] Yes, I can certainly help with that, [PII]. What's the policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where the policy number here. I have an outpatient benefit certificate number. I have a payer ID. Oh, so the outpatient it.
[AGENT][NEUTRAL] Well, yeah, that's it. That's it.
[AGENT][NEUTRAL] Uh, no, the outpatient number, yeah.
[CUSTOMER][NEUTRAL] OK, so it's 0246.
[CUSTOMER][NEUTRAL] 5411.
[CUSTOMER][NEUTRAL] M as in Mary,
[CUSTOMER][NEUTRAL] L 8.
[AGENT][POSITIVE] Great, thank you. If I could just have a verification of the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII] I mean [PII].
[AGENT][POSITIVE] OK, thank you so much. Now while I'm looking that up, if I could just have a callback number, please. I just have to ask. I'm sorry.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's great. Thank you so much. So first of all, um, there, you were asking about uh whether they were active or not. The policy went into effect on, um, let's see what we have here.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII], it is active. Um, now, this secondary or gap insurance will pick up the deductible, co-payment or co-insurance for outpatient surgery up to $5000 per calendar year. Now that is just a verification of the benefits, not a guarantee of payment. And Andre, it doesn't look like any of those benefits have been used. Um, so everything should be available uh for that. Uh, you would just file through their major medical first and then through to us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, is there anything else that I can help with? Would you like our address? Uh, you have our payer ID on the card.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, so if the patient's having a colonoscopy and endoscopy, so how much will be covered?
[AGENT][NEUTRAL] Well, it's, uh, the policy will pick up the deductible, co-payment, or co-insurance up to $5000 per calendar year. And again, like I said, that's just a verification, not a guaranteed payment, but that's the amount that we will pick it up, pick up. The, as I mentioned before, you'll file through their major medical, but we will pick up that deductible, co-payment or co-insurance up to that $5000 amount.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] My insurance up to 5000.
[AGENT][NEUTRAL] Right. Yeah, because we're the gap insurance, so that's, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me one moment, let me just see something.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Now there are a couple of different ways to submit a claim to us, so if you need that information as well, I can help with that.
[CUSTOMER][NEUTRAL] No, that was all that was all the information that she needed. Your name was [PII], right?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference.
[CUSTOMER][NEUTRAL] OK, so gonna be [PII], uh, let me, sorry, let me see, so [PII] and then the reference it will be 42425.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] Alright 04.
[CUSTOMER][POSITIVE] All right perfect right [PII], thank you so much.
[AGENT][POSITIVE] OK, well thank you for contacting APL you have a very good.