AccountId: 011433970860
ContactId: 18c1d308-87ad-4a72-aa4e-bc4eaa936f56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495829 ms
Total Talk Time (AGENT): 135935 ms
Total Talk Time (CUSTOMER): 308936 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/18c1d308-87ad-4a72-aa4e-bc4eaa936f56_20250417T17:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling American Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, the phone's a little bit broken up, but we'll try our best. Um, what do you need from me?
[AGENT][NEUTRAL] I'm needing your name and a callback number first.
[CUSTOMER][NEUTRAL] OK, [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you the provider or the insured?
[CUSTOMER][NEUTRAL] Insured.
[AGENT][NEUTRAL] And could I have your policy number?
[CUSTOMER][NEUTRAL] My policy number is 02564453.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 12 4 1960.
[AGENT][NEUTRAL] May I have your date of birth?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's for
[AGENT][NEUTRAL] And I do need to verify the mailing address, email address.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] On file.
[CUSTOMER][NEUTRAL] OK, email is gonna be [PII].
[CUSTOMER][NEUTRAL] Uh, address is gonna be [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy. How may I assist you?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Well, I am calling about 2. I had uh done 2 claims, um.
[CUSTOMER][NEGATIVE] I don't know, maybe a week or so ago, um, and then I, um, they had reviewed them and we're gonna pay 0 so I called back and talked to another representative and she said, well, wait a minute, this makes no sense. You have all the information here let me send this back to uh investigator and lo and behold by the end of that night um they did say that they were gonna pay um some money and.
[CUSTOMER][NEUTRAL] I do have a res like um I don't know explanation of benefits I guess that has a check number listed on it. So can I assume that a check is probably gonna be in the mail to me shortly for those?
[AGENT][NEUTRAL] May I have the date of service?
[CUSTOMER][NEUTRAL] [PII] and then [PII], um, so [PII] 95 [PII] and then [PII] for [PII].
[AGENT][NEUTRAL] OK. Let me pull that up for you.
[CUSTOMER][NEUTRAL] [PII] or [PII].
[CUSTOMER][NEUTRAL] I wanna do it
[CUSTOMER][NEUTRAL] So and then um I'll probably try and get everyone to fill that out.
[AGENT][NEUTRAL] So for that claim, it does look like it was processed and eligible for payment on [PII], so you do have to allow a total of 7 to 10 business days before that payment can be received within the mail. It's based off of your mailing post office.
[CUSTOMER][NEUTRAL] So I'm just gonna put on uh huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] No worries, no worries. OK, so now today I um put in a new claim because my benefits are supposed to pay up to 1500 each year for eligible services to be, you know, uh, it's gap insurance to be paid back at, um, max of 1500, so for 2024, um, the first claim that I put in, they're only paying me 79,560.
[CUSTOMER][NEUTRAL] So I did, I have a ton of claims, believe me, um, that you know have happened throughout the end of [PII] and beginning of [PII], and I'm just trying to get this all together but so today, uh, since I know that my maximum benefit is 1500, I was filing a new claim, um, where I'm responsible to pay 1,696 62 cents.
[CUSTOMER][NEUTRAL] So I know that my benefit only goes up to 1500, so will, will they understand without me explaining anything since I was already paid 79,560 for the year [PII], they will only pay the difference of this claim up until 1500.
[CUSTOMER][NEUTRAL] Will they know that, um, and they'll know that that's what I'm seeking, or do I need to explain that to somebody?
[AGENT][NEUTRAL] OK. And what date of service is that claim for?
[CUSTOMER][NEUTRAL] So that date of service is gonna be [PII].
[AGENT][NEUTRAL] OK, so this policy effective date is [PII]. So with this policy effective date date being [PII], it does look like for that benefit, is this for inpatient, outpatient, or?
[CUSTOMER][NEUTRAL] This was outpatient.
[AGENT][NEUTRAL] OK, and this is rendered within an outpatient facility?
[CUSTOMER][NEUTRAL] This particular test.
[CUSTOMER][NEUTRAL] It what?
[AGENT][NEUTRAL] It was done within an outpatient facility.
[CUSTOMER][NEUTRAL] Uh, well, it was done at the North Georgia Medical Center in [PII] which
[CUSTOMER][NEUTRAL] It they do inpatient and outpatient the hospital as well.
[AGENT][NEUTRAL] OK, so with this policy verification of coverage does not guarantee the payment of the claim. With the effective date of [PII], you do have up to that $1500 from [PII] up to.
[AGENT][NEUTRAL] [PII], well, up until [PII] or [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Right, OK, cool.
[CUSTOMER][NEUTRAL] And so they'll see that some money has already been paid out for 2024 and then they'll just pay the difference, is that correct?
[AGENT][NEUTRAL] No, from this policy with the maximum amount of the 1500, it is showing that the effective date for that one is [PII]. So from [PII] to [PII], you still have that maximum amount of $1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so on my so for services of [PII].
[CUSTOMER][NEUTRAL] They've already paid or it looks like they're going to pay $795.60.
[AGENT][NEUTRAL] Who's gonna pay?
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] If you look at the explanation of benefits processed on [PII].
[AGENT][NEUTRAL] So that's for the facility bill.
[CUSTOMER][NEUTRAL] The total is 2.
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][POSITIVE] Yes, you're correct. There was an amount of 79,560 that was paid out.
[CUSTOMER][POSITIVE] OK cool.
[CUSTOMER][NEUTRAL] 60, right, and so they'll just pay up until 1500 correct for [PII]. Alright, but so I don't need to explain that to anyone. I just have the claim because the claim is for, uh, you know, the charges were 1600, so it's gonna be way over but it's just to get to the max benefit.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it's once we get to the 1500 maximum benefit, that would be the maximum amount we could pay out.
[CUSTOMER][NEUTRAL] So then,
[CUSTOMER][POSITIVE] Awesome. OK, uh, I appreciate it. Well, thank you. So I think I'm good.
[AGENT][POSITIVE] You're welcome. Is there, OK. Well, I do wanna thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right. Have a good day. Bye.
[AGENT][NEUTRAL] You too bye.