AccountId: 011433970860
ContactId: fd36a4e2-0b9e-4442-a552-42d30665090f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350559 ms
Total Talk Time (AGENT): 100188 ms
Total Talk Time (CUSTOMER): 129802 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/fd36a4e2-0b9e-4442-a552-42d30665090f_20250102T18:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Warren Clinic OBGYN. Um, I'm calling because I have a patient who is trying to use you guys as a secondary coverage, um, and I just had a couple of questions.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from Warren Clinic OBGYN.
[AGENT][NEUTRAL] Thank you, hold on, [PII], just a moment.
[AGENT][NEUTRAL] Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Um, 02349175.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you, [PII], and you were just needing benefits.
[CUSTOMER][NEUTRAL] Um, I, I mean, I have a couple of questions. Are you, are you guys a life insurance policy?
[AGENT][NEUTRAL] No, ma'am. This is a secondary policy that coordinates with their primary.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Are you guys a part of like.
[CUSTOMER][NEUTRAL] I mean you're it says supplemental so are you a part of like.
[CUSTOMER][NEUTRAL] You know, most supplementals are a part of like Medicaid or or Humana like stuff like that, you know what I mean.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, I don't, uh, can I give you like a an NPI? Can you tell me if you're in network with my, my office?
[AGENT][NEUTRAL] This policy doesn't have a network, we just mirror their major medical. It coordinates with their major medical, whatever their major medical applies to their deductible co-pay or co-insurance. Only we pick up certain amounts depending on what type of service it is.
[CUSTOMER][NEUTRAL] OK um.
[AGENT][NEUTRAL] Is it for outpatient, inpatient, doctor's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well.
[CUSTOMER][NEUTRAL] So she is having a surgery, but.
[CUSTOMER][NEUTRAL] It is inpatient and it is.
[CUSTOMER][NEUTRAL] Her primary covers everything except she has a $500 like she has a $250 a day copayment.
[CUSTOMER][NEUTRAL] For the CPT code that's given because it's an inpatient stay so do you guys pick up whatever they don't cover?
[AGENT][NEUTRAL] OK, I can give that to you. Hold on. We don't pick up what they don't cover. We only pick up the deductibles, co-pays, or co-insurances.
[CUSTOMER][NEUTRAL] So you, that's what I mean.
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment. So the effective date is [PII].
[AGENT][NEUTRAL] And for inpatient we'd pay up to 5000 per calendar year.
[CUSTOMER][POSITIVE] OK, um, hang on just one second, I'm so sorry.
[CUSTOMER][NEUTRAL] Can I, can I put you on hold for just a moment? I'm so sorry.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you said um can I give you a CPT code?
[AGENT][NEUTRAL] It doesn't really go by the code. It just goes by inpatient, outpatient, um.
[CUSTOMER][NEUTRAL] OK, so you say that you pick up, you pay.
[CUSTOMER][NEUTRAL] Can you repeat yourself? I'm sorry, I'm just trying to figure this out because I've never, I've never had this. I've never even seen this insurance before, so I'm just trying to figure out what's going on.
[AGENT][NEUTRAL] OK, when the claim comes into us, we look at the explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So whatever the primary on that EOB applies to their deductible, copay or co-insurance.
[AGENT][NEUTRAL] We will pick up
[AGENT][NEUTRAL] Up to $5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mm, OK, um, can I get a reference number for this?
[AGENT][NEUTRAL] We do not have reference numbers you can use my name to in today's date.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][POSITIVE] OK, I guess that's everything that I needed then thank you.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you.