AccountId: 011433970860
ContactId: 05671d1d-e8e4-46e1-86c9-044b0228e120
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253830 ms
Total Talk Time (AGENT): 131159 ms
Total Talk Time (CUSTOMER): 81983 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/05671d1d-e8e4-46e1-86c9-044b0228e120_20250424T14:23_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is easy. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I was calling for eligibility and benefits.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, I have 02506280.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, I have [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Yes, it's gonna be for a specialist office visit and then also for outpatient surgery, professional fees.
[AGENT][NEUTRAL] OK, for all outpatient services, let's see.
[AGENT][NEUTRAL] OK, we cover up to 7500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim, um, with the exception of the co-pay for the office visit. That's not covered.
[CUSTOMER][NEUTRAL] OK, so y'all don't cover the specialist office visit?
[AGENT][NEUTRAL] Not the, not the co-pay, but we'll cover treatment provided in the office, the services that goes towards the coinsurance or the deductible.
[CUSTOMER][NEUTRAL] OK, uh, is there a, uh, deductible and co-insurance on the plan?
[AGENT][NEUTRAL] No, ma'am, there isn't.
[CUSTOMER][NEUTRAL] No? OK, alright, OK, and can you let me know who, what insurance do y'all show as being primary for her? Do y'all have that on file?
[AGENT][NEUTRAL] No, ma'am, we don't keep that on file. We don't know who the primary carrier is until we receive the claim from you guys because the provider submits the claim, um, submits the EOB from the primary insurance company along with the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but just to go over, you say y'all will cover up to $7500 for like any outpatient surgery?
[AGENT][NEUTRAL] Yes, ma'am, per calendar year.
[CUSTOMER][NEUTRAL] Uh, per calendar year.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what about um uh network uh do our doctor has to be in network with this plan, or?
[AGENT][NEUTRAL] Um, no, since we're secondary gap insurance, we go by the primary carrier's guidelines, so there is no network.
[CUSTOMER][NEUTRAL] OK, alright, and just a couple more things if I could just have the claim's mailing address and payer ID and timely filing.
[AGENT][NEGATIVE] Um, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our pay ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the address for claims, um, it's American Public Life.
[AGENT][NEUTRAL] PO [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 248,950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] 8950 OK then alright if I can have your first name again along with last name initial and a possible reference number?
[AGENT][NEUTRAL] Yes, ma'am. The reference number is my name and today's date. Um, my first name is [PII]. It's spelled [PII] My last initial is [PII], and today's date is the reference number. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No, that'll do it, E. thank you.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.