AccountId: 011433970860
ContactId: e8928d56-97dd-4bd8-af66-e6bb95226966
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304239 ms
Total Talk Time (AGENT): 99731 ms
Total Talk Time (CUSTOMER): 170885 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/e8928d56-97dd-4bd8-af66-e6bb95226966_20250225T20:23_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], uh, my name is [PII]. Last name initial [PII], and I'm calling from Primary Children's Hospital's prioritization department. I was calling for the following issue. I have a patient here who's gonna have a surgery with us soon, and I needed to check their benefits. Uh, I also needed to know if authorization will be required for a procedure, if that procedure is covered, and lastly to check if our doctors and hospitals are in network with the patient's plan.
[AGENT][NEUTRAL] I can help with that to know. What is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, policy number is 0245.
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, it's gonna be [PII]. Date of birth is gonna be [PII].
[AGENT][NEUTRAL] Thank you. I just need a contact number please, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Uh, my contact number will be [PII]. It's a direct and secure line.
[AGENT][NEUTRAL] I appreciate that. Thank you. The policy went into effect on [PII]. It is active. Now, for outpatient surgical um services either within a surgery center or a physician's office, we'll pick up the deductible, co-payment or co-insurance up to $350 per calendar day. That is just a verification of the benefits, not a guarantee of payment and uh.
[AGENT][NEUTRAL] We don't uh require pre-authorization. Now, as long as you are in network with the uh major medical and there's a deductible co-payment or co-insurance, uh, then, then we will, um, we can, uh, cover that. I mean, then we would uh be able to pay out the claim, um, but we don't have a pre-authorization of our own because we're the secondary insurance.
[CUSTOMER][POSITIVE] that's great.
[CUSTOMER][NEUTRAL] OK, so essentially if I understood correctly, uh, we are in network with this plan as long as we are in network with the primary insurance, and since you are secondary to the primary insurance, you will not require authorization. You will just follow primary, right?
[AGENT][POSITIVE] That, that is correct, yes.
[CUSTOMER][NEUTRAL] It's not hard because they are secondary.
[CUSTOMER][NEUTRAL] OK, um, very well.
[CUSTOMER][NEUTRAL] Sorry, uh, one question just to know beforehand, in the event that the primary insurance, uh, denies, uh, we can submit an authorization with you or you will just deny as well and not allow us to submit an authorization.
[AGENT][NEUTRAL] Uh, we would deny it as well.
[CUSTOMER][NEUTRAL] OK, we'll deny.
[CUSTOMER][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] OK, perfect. um, very well, you mentioned that there was a, um, deductible of $350 is that correct?
[AGENT][NEUTRAL] No, it's not a deductible, it's a benefit. So we will pay up to $350 per per calendar day. So it's, there's not a deductible with this service or with this policy, that's the benefit. That's
[CUSTOMER][NEUTRAL] OK, so essentially, uh, this patient has no deductible, no out of pocket, no coinsurance, and no co-payment. The only thing that you're gonna cover is $350 per calendar day of the patient, right?
[AGENT][POSITIVE] That, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, very well, let me take note of that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if I have any other questions.
[CUSTOMER][NEUTRAL] Um, and yeah, I was gonna ask you if some CBD codes are covered by the insurance, but I'm gonna assume that you're gonna follow the primary insurance as well, so you're, you're gonna cover if they cover. OK, very well.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, both.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Premium, OK, and just to be sure, anything, any CPD code they they don't cover you do not cover as well.
[AGENT][POSITIVE] That, that would be, that's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry if I'm repetitive with you with the questions I just want to make sure I have all the information.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, uh, just to round up to make sure I got all that information right, uh, we are in that if we are in network with the primary insurance, we're in network with you. Uh, pre-authorization is not required because you're secondary to the primary insurance. You will deny if they deny, but you will cover anything they approve. Is that correct?
[AGENT][NEUTRAL] And that's, yes, up to that $350 for calendar date, which again it's just that verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. OK, I think I have all the information I needed, [PII], can I please ask you for a reference number for our call?
[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 our reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] Not for today thank you so much for your help [PII].
[AGENT][POSITIVE] OK, thanks for contacting API.