AccountId: 011433970860
ContactId: ffdf3f2c-01d9-4137-aa08-15b93539d56c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216949 ms
Total Talk Time (AGENT): 74822 ms
Total Talk Time (CUSTOMER): 90181 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ffdf3f2c-01d9-4137-aa08-15b93539d56c_20250509T13:51_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was calling to see if, um, I could find out if a patient, I guess, has active coverage and, um, what, what the best way are if you guys have like a fax number to send claims to or if it had to be mailed, um.
[CUSTOMER][NEUTRAL] When I go on your website it looks like they can't find the patient, so I just wanted to make sure her plan was active.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] And do you have a phone?
[CUSTOMER][NEUTRAL] And I'm calling with Alliance Surgery Center.
[AGENT][NEUTRAL] OK. And do you have a phone number?
[CUSTOMER][NEUTRAL] Phone number is [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Excuse me, it's 02573495.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Her name is uh [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you wanted to know the benefits on this policy?
[CUSTOMER][NEUTRAL] Yeah, I wanted to know if um if we're an ambulatory surgery center and she's uh trying to use this to cover I guess what the primary um payer push to patient responsibility. I wanted to make sure that she was eligible for coverage.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date is [PII]. Any benefits given over the phone is not a guarantee of payment.
[AGENT][NEUTRAL] This policy does coordinate with the primary insurance. We only pick up what they apply to their deductible, co-pay or co-insurance for outpatients. We'll pay up to $6000 per calendar year, and they have a $100 deductible.
[CUSTOMER][NEUTRAL] Alright, $100 deductible and uh are you showing whether or not she's met her $100 deductible?
[AGENT][NEUTRAL] Hold on just a moment, I'll check for you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] She has met the deductible and she has used $827.81.
[CUSTOMER][NEUTRAL] And um, is there a way to just fax the claims to you guys with her primary EOB, or do you receive that specifically from the primary insurance? Does it usually transfer over like Medicare claims do?
[AGENT][NEUTRAL] No, ma'am, it does not transfer over. You would have to file a claim and yes ma'am, we do accept faxes.
[CUSTOMER][NEUTRAL] OK, um, what would be the fax number I can send that to?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] Thank you, [PII] for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.