AccountId: 011433970860
ContactId: ea765099-802a-4d15-aa8c-b8f2b9c504d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206580 ms
Total Talk Time (AGENT): 102618 ms
Total Talk Time (CUSTOMER): 78208 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/ea765099-802a-4d15-aa8c-b8f2b9c504d7_20250115T23:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with, sorry, I forgot to look where I was calling from Abbott Northwestern Hospital, and I am calling to check eligibility on a patient and to see if they have, uh we are in network for their plan.
[AGENT][NEUTRAL] OK, I can help you with eligibility and network, Ms. [PII]. What is your callback number just in case our call is disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] direct and secure.
[AGENT][NEUTRAL] OK, thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] It is for [PII].
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] 02580145
[AGENT][NEUTRAL] OK, let me pull that policy in real quick.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is a supplemental insurance policy that is secondary to her primary. It's not her major medical, so she does not need to have um
[AGENT][NEUTRAL] A network or pre-authorization.
[CUSTOMER][NEUTRAL] OK, and are is this like a, so her primary plan is the Aetna we have on file. My, my question is, um, so is this something that once we get the uh payment or denial from Aetna, we have to turn around and send it to you or is it something that crosses over from Aetna?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] OK, so how
[CUSTOMER][NEUTRAL] Is it through the same employer or is this an individual policy that she carries?
[AGENT][NEUTRAL] No, it's, it's through her employer and this is uh and this is just to verify her coverage it's not a guarantee of payment. This is a supplemental, uh, you're correct, the supplemental policy that's billed secondary to the primary. It helps with deductible, co-pay and co-insurance only, so.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You would bill the primary the EOB would need to be sent to us after the primary pays their part and then the claim is sent to us afterwards. Uh, she has, if she goes inpatient, she has a calendar year benefit amount of $5000 and outpatient she has a calendar year benefit amount of $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have claims going to [PII].
[AGENT][POSITIVE] Yes, yes, that's correct.
[CUSTOMER][POSITIVE] OK, I will get this set up. Thank you so much for your help.
[AGENT][POSITIVE] You're so welcome, Miss [PII]. I hope you have a great rest of your night, and we thank you for calling APL.
[CUSTOMER][POSITIVE] You're welcome. You too. Thank you.
[AGENT][NEUTRAL] Mm bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye bye.