AccountId: 011433970860
ContactId: 0e8c632a-a419-40d9-8fc2-069a1edc54e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347690 ms
Total Talk Time (AGENT): 178931 ms
Total Talk Time (CUSTOMER): 161347 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/0e8c632a-a419-40d9-8fc2-069a1edc54e6_20250530T16:04_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm, um, an insured on, uh, a gap policy, and I just had a couple questions.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII].
[AGENT][NEUTRAL] Thank you. And do you have your outpatient certificate number with us?
[CUSTOMER][NEUTRAL] Um, hold on, I have, I just logged in. I have something in front of me. Hold on here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I have a policy number and a certificate number. Which one did you need?
[AGENT][NEUTRAL] The policy number is fine.
[CUSTOMER][NEUTRAL] It is um 244-06.
[AGENT][NEUTRAL] OK, that's not a policy number. What is the certificate number?
[CUSTOMER][NEUTRAL] 02587342
[AGENT][NEUTRAL] OK, and if you could verify your date of birth and your mailing address, please.
[CUSTOMER][NEUTRAL] [PII], um [PII].
[AGENT][NEUTRAL] OK, thank you for verifying your account and let's see.
[AGENT][NEUTRAL] And you said today you are calling um in reference, uh, you just have a few questions about your policy?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK. And how can I help you today?
[CUSTOMER][NEUTRAL] So, um, July, I can't remember the date, [PII], I think.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look at my calendar.
[CUSTOMER][NEUTRAL] Um, yeah, the [PII], I believe. We have a surgery scheduled for our daughter. Um, she's the, uh, listed on there too, [PII]. And I just wanted to see if this gap insurance, I think it should kick in a little bit. Um, basically, she's having surgery to remove, uh, extra toes on her pink on her feet.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, on either side. I forget the medical name, [PII], uh, I guess removal, whatever it is, um, so I just wanted to see what the, I, I think the gap insurance would kick in in something like this, but I just wanted to confirm that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. So is this going to be, is she gonna be admitted or is this just a day surgery?
[CUSTOMER][NEUTRAL] I think like overnight you mean?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Admitted overnight. I don't think it's gonna be something overnight. It's gonna be in like a surgical, it's outpatient in a surgical center. It's not at the, uh, yeah, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Surgical center, OK.
[AGENT][NEUTRAL] OK, OK. So, uh, please be advised verifying benefits does not guarantee payment. So your policy would kick in for outpatient surgery. Um, it would pay secondary to your major medical and it looks like for outpatient benefits, the policy pays up to $500 a day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Up to 500 a day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so would it be best to provide it up front or just submit it afterwards or what's the.
[AGENT][NEUTRAL] Well, the best thing to do is to submit your, um,
[AGENT][NEUTRAL] APL information. So when you submit your insurance information, let them know you do have a secondary policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so you want to give them both. Most providers will file the claim for you. So they'll file to your primary, get your explanation of benefits back, and then they will file with us, uh, for about, you know, if there's patient patient balance. Um, if they uh will not file on your request.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, I mean, on your behalf, I'm sorry, what you want to request is go ahead and request your, uh, admit, uh, documents, um, that shows and just let them know you needed to show the ICD pin code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And then once they file to your primary, you get your explanation of benefits back saying that you owe whatever amount for the surgery, then you can submit your paperwork yourself.
[AGENT][NEUTRAL] And we will pay you directly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I just wanna make sure something too because I noticed that um my wife, she had an emergency room visit uh in March and um we did submit, I think they did submit it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And I see it's paid, but I got, I think we got a letter from the hospital saying that we need to contact you guys. I'm not sure, maybe the letter they sent was sent before payment was issued, maybe I'm not sure.
[AGENT][NEUTRAL] Uh, let me see. OK, so it looks like they did submit it, but they submitted it without your primary showing us how much you owed. Uh, and so that's probably the document you received letting you know, hey, we, we received the claim on you, but we requested the explanation of benefits, so they did send it, uh, and then it looks like on [PII] uh it paid up to the $500.
[CUSTOMER][NEUTRAL] Because I have the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so I don't need to do anything.
[AGENT][NEUTRAL] So I paid a maximum of $500 to the hospital.
[CUSTOMER][POSITIVE] Yeah and I think that was our our copay anyway so OK so we don't need to do anything on that one I'm, I'm assuming. OK, sounds good. Alright, thank you so much I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, no, sir. That's been taken care of.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Nope, that'll be all.
[AGENT][POSITIVE] OK, you have a wonderful weekend. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.