AccountId: 011433970860
ContactId: f124a145-f356-4e16-bfad-28a553536beb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 186199 ms
Total Talk Time (AGENT): 81875 ms
Total Talk Time (CUSTOMER): 94137 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f124a145-f356-4e16-bfad-28a553536beb_20250123T16:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning. I'm calling from an ambulatory surgical center and I have a patient that has um APL as like a gap insurance. I just wanted to confirm coverage and benefits with you for the procedure that she'll be having.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, I'll need your name and a good callback number.
[CUSTOMER][NEUTRAL] My name is [PII] and a good call back number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It is 01530968.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] I have here [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active, and you said this is for outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so she's having surgery here with our facility. It's outpatient ambulatory Center.
[AGENT][NEUTRAL] OK, for outpatient services, we cover up to 1250 per calendar year and that's for the co-pay, the coinsurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] Perfect. So just to confirm, you said 1250 per year, right?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] Got it and has the patient used any of this amount or this is the full amount that we would get if we do submit this claim?
[AGENT][NEUTRAL] Right, the full amount is available. She hasn't used any this year.
[CUSTOMER][NEUTRAL] Got it, perfect. And then question, you guys will pay after uh the primary insurance pays and like my question is do we charge the patient and then you reimburse the patient or you will pay us directly?
[AGENT][NEUTRAL] We'll pay you directly. What normally happens is that the provider will file the claim first and then when the provider receives the EOB from the primary insurance, they'll file the claim with us along with the EOB.
[CUSTOMER][POSITIVE] Got it. OK, perfect. And this is uh and this is covered for any co-pay, deductible, co-insurance, anything for any outpatient procedures, correct?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][POSITIVE] Perfect and can I have a reference number and your name for this call, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII] like [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much for your help.
[AGENT][POSITIVE] OK. Thank you, [PII], for calling APO. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you.