AccountId: 011433970860
ContactId: e43765a2-5867-475e-b15c-c9f39a06a27c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222710 ms
Total Talk Time (AGENT): 90083 ms
Total Talk Time (CUSTOMER): 111397 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/e43765a2-5867-475e-b15c-c9f39a06a27c_20250520T17:22_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from NYU Langol Hospital, trying to get some clarification on a benefit card um that the patient has forwarded to me.
[AGENT][NEUTRAL] OK, [PII], I can help you with that. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, and do they have a policy number on that card?
[CUSTOMER][NEUTRAL] Um, oh yeah, here, certification number, would that be it?
[AGENT][NEUTRAL] Yes, that's it.
[CUSTOMER][NEUTRAL] OK, 01616382 ML 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] This is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, and how can I help you today?
[CUSTOMER][NEUTRAL] Um, this patients coming in for a sleep study. They did present a, uh, primary insurance carrier with Aetna. I gave them an estimate, um, for the cost, the patient then returned a copy of this card. Um, so I'm trying to figure out what network it follows. Is it an insurance plan?
[AGENT][NEUTRAL] OK, um, uh, let me see. So the policy is effective [PII].
[AGENT][NEUTRAL] Um, this is not a guarantee of payment basic outline of the policy. So will this be sleep study and outpatient hospital setting?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] So this policy is like a secondary gap policy. So once primary processes the claim, this policy um comes in and picks up any applicable deductible co-pay, co-insurance for outpatient hospital services.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So does the patient submit the claim to you guys? Or the hospital does?
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] If y'all will file it for him, we, we would pay you if there's assignment of benefits um for this, yeah, so this policy processes and pays up to 1500 per covered person per calendar year um so whatever is left over from primary we pay up to 1500.
[CUSTOMER][NEUTRAL] Oh, really?
[CUSTOMER][NEUTRAL] Oh wow, OK, so this patient has $3000 left over, so you'll only pay $1500 of the $3000.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] That's OK. I just don't know, so there's no, it doesn't follow a network?
[AGENT][NEUTRAL] No, because it's secondary.
[CUSTOMER][NEUTRAL] Like a
[CUSTOMER][NEUTRAL] OK, I guess what I'm trying to do is trying to fit it in our guidelines um to use as a secondary, and they require it to follow a network.
[CUSTOMER][NEGATIVE] But you are, you're just pretty much a cash plan that gives up to $1500.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I mean we, we coordinate with the primary so we pick up what's left over from primary and pay up to 1500.
[CUSTOMER][NEUTRAL] So there's no
[CUSTOMER][NEUTRAL] OK. The patient can submit the claim to you guys though, right?
[AGENT][NEUTRAL] Yes, um, if you provide them the like UBO4 cause we're gonna need procedure codes, diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have no idea what to do with this. Thank you so much. I have to escalate it. Can I just your name and a reference number please?
[AGENT][NEUTRAL] Uh, my name is [PII]. First initial last name is [PII], and today's date. And anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] No, you were very helpful. Thank you, [PII].
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.