AccountId: 011433970860
ContactId: 048cbd21-4b08-4878-a8ef-5ab881902661
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339010 ms
Total Talk Time (AGENT): 147986 ms
Total Talk Time (CUSTOMER): 124823 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/048cbd21-4b08-4878-a8ef-5ab881902661_20250501T16:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], how are you? Good afternoon.
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][NEUTRAL] Good, good. Um, I had, um, I had a procedure done and I paid a deductible, but I didn't remember that I had the, the gap.
[CUSTOMER][NEUTRAL] Um, the gap insurance?
[CUSTOMER][NEUTRAL] So I wanted to see how does that work towards the bottom that I just paid about 2 weeks ago.
[AGENT][NEUTRAL] OK. May I have your name and then the callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Group group individual.
[AGENT][NEUTRAL] It will be the benefit certification.
[CUSTOMER][NEUTRAL] Uh, uh, in-hospital benefits certification or outpatient benefits extension number?
[AGENT][NEUTRAL] They're both the same. You will stop at the number before the letter M.
[CUSTOMER][NEUTRAL] So 202583259.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth and mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it does look like we have an email address on file. Could you verify that for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much for verifying your policy. Was this for inpatient, outpatient or an office setting?
[CUSTOMER][NEUTRAL] Um, well, I had an endoscopy and a colonoscopy done.
[AGENT][NEUTRAL] OK, so this was done within an outpatient facility?
[CUSTOMER][NEUTRAL] It was all I went in at home.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for it to be reimbursed if possible, you would have to submit in the primary EOB showing your responsibility for that data service.
[AGENT][NEUTRAL] The discharge papers or documentation from the provider showing the diagnosis code for that procedure.
[CUSTOMER][NEUTRAL] OK, so primary, for my, for my primary doctor, I have to get what?
[AGENT][NEUTRAL] From your primary insurance, you will get a primary EOB which is showing your patient's responsibility, which was your deductible co-insurance or co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] Then from the provider, go ahead.
[CUSTOMER][NEUTRAL] Um, then what?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That render the services, go ahead.
[CUSTOMER][NEUTRAL] When I did the procedure, the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So when I did the when I had the procedure, the papers that they gave me when they discharged me.
[AGENT][NEUTRAL] Yes, the paper should either have the reason that they did the procedure. If it doesn't, then you will have to contact that provider that rendered the services and request that diagnosis code, and it will have to be either on their letterhead and shows that date of service.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me call my insurance first, get that, and then the people that did the procedure, I have the paperwork at the house, they should have all that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then also the receipt of the amount I paid out, right?
[AGENT][NEUTRAL] We don't go by the receipt, we basically just go by your primary insurance showing how much they applied.
[CUSTOMER][NEUTRAL] Primary insurance EOB for that procedure, right? for the procedure I did.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right procedure, OK, right, and then what do I do with this? I load it up online or something if I open an account or how?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For it, have you already set up the secured portal?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so on that card it should say that you have the [PII].
[AGENT][NEUTRAL] And you will set up a username and password, you will be able to submit the claims there or you can fax it in or mail them in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and there's a link that'll tell me claims and stuff like that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK alright cool thank you appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it. Oh, another thing, let me ask you, um, I know this is a gap insurance, so it, it should, it should take care of that. But let's say I go to for a primary doctor and I have, uh, a deductible, does that also get taken care of by you guys or no?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For a primary care visit, let me pull that up for you.
[AGENT][NEUTRAL] So for your policy verification of coverage does not guarantee the payment of the claim. You don't have the office visit or office procedure benefit rider listed on this policy.
[CUSTOMER][NEUTRAL] OK, office visit?
[CUSTOMER][NEUTRAL] And office procedure, right?
[AGENT][NEGATIVE] Correct, you don't have that benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and that could be added or or or or no?
[AGENT][NEUTRAL] You will have to check with your HR department to see if that can be added to the policy.
[CUSTOMER][NEUTRAL] So it will be any emergency care and outpatient care type of deal, right?
[CUSTOMER][NEUTRAL] Other than Optus visit.
[AGENT][NEUTRAL] It looks like you do have inpatient and outpatient benefits.
[CUSTOMER][POSITIVE] Inpatient, outpatient. OK, cool. Alrighty, thank you.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye.