AccountId: 011433970860
ContactId: e90ea4b0-873b-40a2-ba01-4da6d8f31b97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312950 ms
Total Talk Time (AGENT): 97877 ms
Total Talk Time (CUSTOMER): 140644 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/e90ea4b0-873b-40a2-ba01-4da6d8f31b97_20250618T15:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah. Uh hello. Uh, this is [PII] from the provider billing office, Simon call LLC. I want the eligibility for uh a patient. Could you please verify?
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you?
[CUSTOMER][NEUTRAL] Uh yeah, sure. It's
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can I have that policy number of the member that you're calling to verify benefits for today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The member's ID right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] 261.
[CUSTOMER][NEUTRAL] 1585.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The date of birth of uh the patient is [PII].
[AGENT][NEUTRAL] So I didn't hear, so [PII], could you give me the policy number again?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, it's 261.
[CUSTOMER][NEUTRAL] 1585.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Her date of birth is [PII].
[CUSTOMER][NEUTRAL] And her last name is [PII]. Her first name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you're calling to verify benefits you're calling to verify benefits and eligibility for the member.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is [PII], what is the date of birth again?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you and [PII], you're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] You're welcome, ma.
[CUSTOMER][NEUTRAL] OK, it's.
[AGENT][NEUTRAL] Inpatient, outpatient, office visits?
[CUSTOMER][NEUTRAL] Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] Yeah, I need the office visits and office procedures as a secondary insurance.
[AGENT][NEGATIVE] Go off
[AGENT][NEUTRAL] So the member's policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The member's policy does not cover the office visits, however, it does cover the treatment received in the office which falls under the outpatient benefits of $3,575 per calendar year.
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And uh the, the amount is 3500 for the whole year, right?
[AGENT][NEUTRAL] Yes, that is correct, and the member has not utilized any of their benefits for [PII].
[CUSTOMER][NEUTRAL] And it's outpatient visits, not inpatient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you uh confirm two codes for me if those are covered?
[AGENT][NEUTRAL] We don't need though. This is the gap insurance that assists with the deductible co-pay and co-insurance to the primary. So we don't need a diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, cause uh uh I need to know, um.
[CUSTOMER][NEUTRAL] Uh, if, if it covers is secondary.
[AGENT][NEUTRAL] This is the primary, this is the gap insurance that pays the deductible, co-pay and co-insurance amount towards the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it doesn't matter if uh it's uh it's an office visit or it's uh any kind of visit. The primary covers, the secondary covers the gap.
[AGENT][NEUTRAL] Yes, that is correct. If the primary doesn't make a payment, then the secondary is not gonna make a payment.
[CUSTOMER][NEUTRAL] OK. If the primary is going to make a payment,
[CUSTOMER][NEUTRAL] Then for sure, it doesn't matter if it is in deductible or co-insurance or co-pay, it's going to pay.
[AGENT][NEUTRAL] If the primary make a payment and it went towards deductible, co-pay and co-insurance, then the gap insurance would assist with that payment. But you have to submit the primary ELB with along with the claim here to American Public Life. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, ma'am. That, that would be all. Uh you answered my question. Thank you so much.
[AGENT][POSITIVE] Thanks for calling APL [PII]. Have a good one. Goodbye.