AccountId: 011433970860
ContactId: 25a99de6-47a0-452c-b1a7-d21be4b6f477
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480000 ms
Total Talk Time (AGENT): 206047 ms
Total Talk Time (CUSTOMER): 174714 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/25a99de6-47a0-452c-b1a7-d21be4b6f477_20250219T13:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Very good morning to you, [PII]. This is [PII] calling from the provider's office. How are you doing this morning?
[AGENT][POSITIVE] I'm doing well. And you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] And the initial to my last name is [PII]. And can I get your initial for the last?
[AGENT][NEUTRAL] Uh, the first initial is [PII].
[AGENT][NEUTRAL] And [PII], what is your callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And how can I help you today?
[CUSTOMER][NEUTRAL] Uh, well, [PII], I'm calling in today to get benefits and eligibility for one of our clients with
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] American Public Life Insurance. So I need basic information on your plan. So, would you be the right person?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you need eligibility and, yes, sir, you're needing eligibility and benefits, correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For one member? Yes, sir. I can help you. And what is the member's policy number?
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh, the member's policy number I have is 2011238.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please. I'll send to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information I'll send that I that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, the patient's first name is [PII]
[CUSTOMER][NEUTRAL] And her last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy, [PII].
[AGENT][NEUTRAL] And the policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit or information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, well, uh, we are calling from the
[CUSTOMER][NEUTRAL] Physician office, so it's an office visit. I've got a few selected questions of my own, [PII], so I would really appreciate if you could uh help me with those questions and answers only.
[CUSTOMER][NEUTRAL] So you've given me the effective date on the plan and there is no term date. Uh, would this policy be considered primary or secondary to the client?
[AGENT][NEUTRAL] No, sir. As I stated, this is a supplemental policy to her primary insurance. We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you are secondary.
[CUSTOMER][NEUTRAL] And the primary is Medicare.
[AGENT][NEUTRAL] Uh, no, sir, that is not what we have. We have a primary, uh, private insurance for her. Major medical.
[CUSTOMER][NEUTRAL] Major medical.
[AGENT][NEUTRAL] We show her major medical is Anthem Blue Shield.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So Blue Shield is primary and you are secondary.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, and your insurance, uh, what is the timely filing?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] No how filing limit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Do you have a PR ID, electronic PID for claim submission?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, and you will also need to submit.
[CUSTOMER][NEUTRAL] What about facts?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 18773659423 attention claims.
[CUSTOMER][NEUTRAL] OK, what's the [PII] box address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] All right, related to benefits, I would like to know, does this client has
[CUSTOMER][NEUTRAL] Uh, office was a co-pay for a PCP and for a specialist.
[AGENT][NEUTRAL] OK, there are, this policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK. So your plan does not cover office visit at all.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And if the member goes, that would be his responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And that would be for any office for, would it be PCP or would that be for any specialist?
[AGENT][NEUTRAL] Office visits of any type are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm. With your policy do you have or does, does member have any annual deductibles out of network or in-network co-pay, deductibles or out of pocket max?
[AGENT][NEUTRAL] There is, no, sir, again, this is a supplemental policy. It is not a major medical policy. This policy does have outpatient benefits for covered outpatient services.
[CUSTOMER][NEGATIVE] Mm, it does not go.
[AGENT][NEUTRAL] And the outpatient calendar year maximum benefit for those covered outpatient services is $1500 per covered person with no outpatient deductible.
[CUSTOMER][NEUTRAL] All right. Uh, could you check if, uh, this, uh, physician who I'm calling in regards to, does it fall as a participation or non-participation provider?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] There is no network affiliated with [PII]. This would follow her primary insurance.
[CUSTOMER][NEUTRAL] For this member.
[CUSTOMER][NEUTRAL] All right, what's the reference number to this call?
[AGENT][NEUTRAL] It would be my name along with today's date, and should you all end up filing a claim with us, [PII] for this member, you would also need to send us a copy of the primary insurance company's explanation of benefits as well along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check claim status and and also have access to our explanation of benefits, and that website for our portal is [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Yes sir, thank you.