AccountId: 011433970860
ContactId: 1678789f-0caf-4470-a005-18c35679f82a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292089 ms
Total Talk Time (AGENT): 190925 ms
Total Talk Time (CUSTOMER): 84830 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/1678789f-0caf-4470-a005-18c35679f82a_20250617T14:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling American Public Life, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII]. I have the APL. I have not yet used it and I just had a couple questions, hoping I reached the right person.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I can help uh I can give you, uh, I can help you out with that. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] 622
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have your policy number with us?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 564.
[CUSTOMER][NEUTRAL] 52.
[AGENT][NEUTRAL] What are what are the last two numbers?
[CUSTOMER][NEUTRAL] 52.
[AGENT][NEUTRAL] 52.
[AGENT][NEUTRAL] OK, if you could verify um your date of birth and mailing address please.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying your account and [PII], you're calling uh because you have some questions on the policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And how can I help you?
[CUSTOMER][NEUTRAL] Uh, I just had 111 actual question now as far as this goes, I, I, um.
[CUSTOMER][NEUTRAL] Submit my own claim.
[AGENT][NEUTRAL] No, no. So, uh, the only time you want to submit a claim is if you uh have a doctor's appointment and they are telling you they will not file the claim for you. Um, most of the providers will file secondary on your behalf and then we pay them directly. Uh, so the only time you, you want to file a claim yourself is if, um, is that maybe a service that's, uh, you know, they will not.
[CUSTOMER][NEUTRAL] Is that how that works?
[AGENT][NEUTRAL] File the claim for you. And if that happens, I can let you know what information you want to ask for at that moment, so you can file your claim.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I'm having, I'm having eye surgery on Thursday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the officers telling me that they weren't sure they were getting conflicting whether I filed or they filed it as my secondary.
[AGENT][NEUTRAL] Yeah, you just let them know this is a secondary policy, uh, they, uh, can file the claim secondary and, uh, we do pay them directly. Um, they can give us a call and verify your benefits, you know, so they know.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What, what, how your policy would cover the procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and what do they cover for surgery, do you know?
[AGENT][NEUTRAL] So, um, please be advised verifying benefits is not guaranteed payment. Is the surgery done in the doctor's office or is it going to be done in an outpatient surgery center or facility?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It, it's just part of their office.
[AGENT][NEUTRAL] OK, OK. So for uh procedures done in the office, uh, that would be covered under your outpatient benefit. It pays up to $500 a day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's for the procedure.
[AGENT][NEUTRAL] So that would be for all services on that day, that would be covered under outpatients. So that would be the doctor, um, whatever you're being billed for, um, you know, for that procedure. So if it's the doctor billing the procedure,
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um, and your policy will pay up to $500. Let's just say if this is a surgery where you had to go into a hospital. So you would have your doctor's charges and also the hospital charges. It's still the $500 a day and it would be based on
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, who files the claim first. So, if the doctor files the claim, their bill is $300 then we pay, you know, they filed the claim, we pay them the $300. If the hospital comes after them and files a claim for the same date, and let's just say what you owe them is $600. At that point, you only have $200 left. So we would pay the remaining $200 and then, you know.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let them know you've maxed out that benefit for the day so um the 500 would be for the provider.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][POSITIVE] OK, so they both could they both would be able to file. I got you I got you. Thank you so much. That answered my question. That's all I needed.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, [PII], you have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][POSITIVE] You do the same thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.