AccountId: 011433970860
ContactId: 02306722-f55f-4a5f-9cf5-dbaa7d9ee51c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274809 ms
Total Talk Time (AGENT): 129887 ms
Total Talk Time (CUSTOMER): 121691 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/02306722-f55f-4a5f-9cf5-dbaa7d9ee51c_20250130T19:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey there, uh, my name is [PII] and I'm calling from, uh, Vanderbilt Radiation Oncology in [PII], and we have a patient that's here, um, and he has the APL as a as a secondary insurance or supplemental, um, and I just wanna verify if there's any benefits or whatever because we've never heard of this one, can you verify that he's eligible or?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me the, the the does he have do they have like a deductible and all that with with APL?
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Would that be the group number?
[AGENT][NEUTRAL] It will be the outpatient benefit certification number.
[CUSTOMER][NEUTRAL] Oh, OK, here we go, 02148767 ML 8.
[AGENT][NEUTRAL] And may I have a callback number please?
[CUSTOMER][NEUTRAL] Uh huh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh huh, [PII] and [PII].
[AGENT][NEUTRAL] And this is for an office, outpatient, inpatient?
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] Pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can give you our tax ID.
[CUSTOMER][NEUTRAL] As well if you need it or MPI.
[AGENT][NEUTRAL] OK, now for this policy verification of coverage does not guarantee the payment of the claim. It is showing that the member is currently active. The effective date is [PII].
[AGENT][NEUTRAL] For this policy, it is a supplemental or gap to their primary insurance. For the office visit, the member does not have the office visit benefit rider, but for a procedure that is rendered within an office setting, the member has up to $5000 per calendar year in which that will go towards the primary insurance deductible, co-insurance, or co-pay for the procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy is only for sickness and injury. It will not cover any preventative or wellness.
[CUSTOMER][NEUTRAL] So would it cover, so he's here in the office for a consultation so it won't cover that?
[AGENT][NEUTRAL] If it's for the office visit fee, which is the co-pay, we do not cover that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then what about um like if he were to have radiation therapy where he'd come in every day, would that be covered due to cancer?
[AGENT][NEUTRAL] If it's for, if it's for procedures running within an office setting, the member does have up to the 5000. Now, if this is for cancer treatment, let me see if they have that benefit writer as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there a copay each visit?
[CUSTOMER][NEUTRAL] I mean I'm assuming no.
[AGENT][NEUTRAL] Now that is based off of the primary insurance, how they bill it. If the primary shows this as a procedure, not an office setting, I mean not an office visit, then we will cover up to that $5000 for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5000.
[CUSTOMER][NEUTRAL] OK, so really the, the primary insurance will just bill you send whatever's left to you, so basically just like a supplemental insurance.
[AGENT][NEUTRAL] They will submit the EOB and information over to you showing that they have a responsibility. Once that primary insurance processes it, then you will submit the claim and that primary EOB over to us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we will submit payment to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If possible.
[CUSTOMER][NEUTRAL] OK, OK, and then is it like an in network out of network thing or like can you check to see if we're in network with you all?
[AGENT][NEUTRAL] It's based off of the primary insurance.
[CUSTOMER][POSITIVE] Primary? OK good OK all right well I know that answer so that's good alright well thank you very much.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, that's it.
[AGENT][POSITIVE] Well I do wanna thank you so much for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] All right you too thank you.
[AGENT][POSITIVE] Thank you.