AccountId: 011433970860
ContactId: 1ddf2d66-6a89-4d3c-b0c2-260fe3d7ccb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312170 ms
Total Talk Time (AGENT): 172437 ms
Total Talk Time (CUSTOMER): 109009 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/1ddf2d66-6a89-4d3c-b0c2-260fe3d7ccb4_20250113T16:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Whom am I speaking to? How may I help you?
[CUSTOMER][NEUTRAL] Hello. Good morning, [PII]. My name is [PII] and I'm calling from the provider's office. I'm trying to verify coverage for a patient, please.
[AGENT][POSITIVE] OK, [PII], I can assist you with that coverage today. What is a good callback number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, and what's the policy number you're calling regarding?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] 02580148.
[AGENT][NEUTRAL] Thank you for that information. And one moment while I get that policy pulled up.
[AGENT][NEUTRAL] Verification of coverage does not guarantee the payment of a claim. You're welcome. What is the member's name and date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII], and the last name is um [PII]
[AGENT][NEUTRAL] Thank you. So this member has an effective date of [PII] and the policy is currently active. Do you need any type of benefit information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, is that for uh physician's office?
[CUSTOMER][NEUTRAL] Well, uh, she's having surgery due to the breast cancer. And so she has a, a medical policy, but she mentioned that she has this, uh, she was calling it GA, but I'm not sure if this is uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and that's
[AGENT][NEUTRAL] It is a gap insurance, so let me get to her benefits to see what type of benefits she has.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is a gap insurance so it's secondary. It will only consider copays, co-insurance or deductibles that the primary insurance says that the member is responsible for. When you file a claim, you'll file that same claim that you filed to the primary insurance company. You just need to send the EOB as well so we can see what her responsibility was. Um, I'm showing for outpatient, she has an outpatient calendar year of $1000 per year, OK.
[AGENT][NEUTRAL] And let's check and see if she's used any of that so far.
[CUSTOMER][NEUTRAL] So it's the outpatient um.
[CUSTOMER][NEGATIVE] $1000 cause the call keeps breaking. So, it's $1000 is what you cover.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The outpatient benefit goes up to $1000 per year. We'll only consider what her primary insurance that she's responsible for.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I understand that.
[AGENT][NEUTRAL] So, OK, mhm, so those are the benefits, mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But what is the $1000? Is it the maximum coverage after the primary pays?
[AGENT][NEUTRAL] This is a secondary gap insurance and the maximum outpatient calendar year benefit is $1000.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] She has not used any of that so far. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, so after the $1000 it's, it's her responsibility.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] We don't, we don't get into that, ma'am. We, we're the insurance company. When you send us a claim, we process the claim according to the benefits or policy, and if something is available, we'll process it accordingly. So you would have to file a claim, receive your EOB as to whether it was paid or denied, OK? And then you make that decision as a provider as to whether she's responsible or not. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh, I just wanna make, well, I just wanna make sure that I understand you correctly, that you pay.
[CUSTOMER][NEUTRAL] Up to $1000. That's what the gap coverage is.
[AGENT][NEUTRAL] Again, her outpatient calendar year benefit goes up to $1000 per year.
[CUSTOMER][NEUTRAL] So we just need to cancel OK. And where do we send the claim to? Tell me an address or a payer ID or something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We have, we have an electronic payer ID of 60801.
[AGENT][NEUTRAL] And let me know when you're ready for the mailing address if you would like that.
[CUSTOMER][NEUTRAL] OK. Can you repeat the payer ID? It keeps cutting off.
[AGENT][NEUTRAL] 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, repeat the zip code again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII], what is the first initial of your last name and a call reference number, please?
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] The call reference is my name [PII], last initial [PII] in today's date, and thank you [PII] for calling APL. You have a great day and take care.
[CUSTOMER][NEUTRAL] And what is the name of the company again?
[AGENT][NEUTRAL] This is American Public Life.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.