AccountId: 011433970860
ContactId: fa2761af-e4ec-483f-8a24-629631fd81b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459779 ms
Total Talk Time (AGENT): 198985 ms
Total Talk Time (CUSTOMER): 202115 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/fa2761af-e4ec-483f-8a24-629631fd81b8_20250310T15:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. So I need to verify uh insurance benefits.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII], last initial [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, the number is [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], you're calling from which facility for annotation?
[CUSTOMER][NEUTRAL] Um, actually I'm calling from a doctor's office.
[CUSTOMER][NEUTRAL] But I'm, he's planning on having surgery, so I need to know um office, outpatient and hospital.
[AGENT][NEUTRAL] What's the name?
[AGENT][NEUTRAL] OK, so you need um office benefits and inpatient hospital.
[CUSTOMER][NEUTRAL] Mhm, please.
[AGENT][NEUTRAL] OK. OK. And what's the name of the doctor for my notation?
[CUSTOMER][NEUTRAL] Uh, it is going to be Doctor [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, I think it's, hold on, let me just make sure.
[CUSTOMER][NEUTRAL] No, I'm sorry, Doctor [PII]. That's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The number I have, I have his social and it's [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK bear with me.
[CUSTOMER][NEUTRAL] I'm not exactly sure what his policy there's a certain number for in hospital and outpatient, but I don't know um.
[CUSTOMER][NEUTRAL] What is correct.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's gonna be it. That's the policy number, the first part of it without the email, um, let me go ahead and pull his information. One moment.
[CUSTOMER][NEUTRAL] Do I have to have the ML on the on the ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you don't have to. That's just indicating what product is it and yeah, the policy number will pull that information, um, and.
[CUSTOMER][NEUTRAL] OK, so if I, if I bill it with just um let's see, the number I have is 02300713 if I bill it with those digits, it'll be OK.
[AGENT][NEUTRAL] Yeah, that will be sufficient.
[CUSTOMER][NEUTRAL] OK, let me correct that then.
[AGENT][NEUTRAL] All right. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it is um [PII] or I'm sorry, [PII] Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you. OK, let me look for it innocent.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is a secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] And with this one, yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So 4
[CUSTOMER][NEUTRAL] Do you have an effective date?
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] It is active at the moment.
[AGENT][NEUTRAL] We have an inpatient maximum benefit of 5000 per person per calendar year.
[AGENT][NEUTRAL] And then we have an outpatient benefit maximum of 2500 per covered person per calendar year. Uh, this one doesn't cover office procedures or treatment. It's only for outpatient facilities, surgical centers, hospitals.
[CUSTOMER][NEUTRAL] So there's
[CUSTOMER][NEUTRAL] The office visit coverage, OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right, so if he goes in the hospital for outpatient and has like a colonoscopy, um, we're colorectal specialists, so if that would be covered for the doctor, correct?
[AGENT][NEUTRAL] Yes, as long as it's a diagnostic testing, not a preventative, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So nothing preventative.
[AGENT][NEUTRAL] No, because we're the secondary, we're not the major medical, and that's usually pay 100% by the major medical, so it's not something that is covered under the secondary.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright and then um.
[CUSTOMER][POSITIVE] It does cover professional fees though, correct? It's just, it's not facility only, it's, it's professional as well, correct.
[AGENT][NEUTRAL] As, as long as the procedure is done in an outpatient facility or hospital. Correct.
[CUSTOMER][NEUTRAL] OK, and you do show United Healthcare as the primary um.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Insurance and then you're secondary.
[AGENT][NEUTRAL] Let me make sure that is right.
[AGENT][NEUTRAL] Yes, United Healthcare is this primary. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then um does it cover deductibles?
[AGENT][NEUTRAL] Um, this policy is set up to help with the deductibles, co-payment, and co-insurance up to the maximum of the benefit, which in this case the outpatient is 2500 and the inpatient is 5000.
[CUSTOMER][NEUTRAL] OK, can you tell me what the accumulative is so far for this year?
[AGENT][NEUTRAL] Mhm. Sure. Let's see.
[AGENT][NEUTRAL] As of today, for [PII], he has not used his benefits, so he still have the full amount available.
[CUSTOMER][NEUTRAL] So he has inpatient 5000 and outpatient 2500, so it does cover um all co-pays, co-insurance, deductibles, everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Up to the allowed amount of 2500 or 5000.
[AGENT][NEUTRAL] As long as it's a covered place of service again office or office procedures or office visits are not covered, um, if the procedure takes place in an outpatient facility or hospital, then it will be considered.
[CUSTOMER][NEUTRAL] What about at a freestanding facility?
[AGENT][NEUTRAL] If it's safe for extending surgical center, that is an outpatient facility, yes.
[CUSTOMER][NEUTRAL] So that's covered, so anything outpatient facility, yes and inpatient, yes, got it. OK, and that's the only stipulation, correct?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes, mhm, correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, real good. Alright, so can I have a call reference number or is it just your name and today's date?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] OK, wonderful. OK, thank you so much dear have a great day.
[AGENT][POSITIVE] You're welcome. You are so handy.
[CUSTOMER][NEUTRAL] Oh, and the claim and the claims go to 248,950 Oklahoma?
[AGENT][NEUTRAL] Homer City, Oklahoma, yes. 73124. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, got it.
[CUSTOMER][POSITIVE] OK wonderful thank you so much have a great day.
[AGENT][POSITIVE] You're welcome. You as well, Miss [PII], and thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.