AccountId: 011433970860
ContactId: 2a892d29-2b29-42ac-8f2a-62c792bde400
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278690 ms
Total Talk Time (AGENT): 84963 ms
Total Talk Time (CUSTOMER): 158386 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/2a892d29-2b29-42ac-8f2a-62c792bde400_20250228T14:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi, good morning.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can I give you my uh policy number?
[AGENT][NEUTRAL] Yes, may I have your policy number please?
[CUSTOMER][NEUTRAL] It's 186-7002.
[AGENT][NEUTRAL] And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth and the mailing address listed on file?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And we do have an email address on file. Could you verify that to make sure it's correct?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, um, I'm, I just wanted some information. So I had a, uh, procedure done on Monday and, uh, you know, I have major medical with United and, um, but I have a high deductible, so I just wanted to see what is my policy cover with you guys, uh, in a, in a situation like that.
[AGENT][NEUTRAL] Is this procedure gonna be rendered within an office sitting or an outpatient facility?
[CUSTOMER][NEUTRAL] It was done in an outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it's, I think he, they, they notified you guys, um.
[CUSTOMER][NEUTRAL] Well, explain to her the procedure so she's aware. You went to an outpatient facility. We had a deductible of. Yeah, so, you know, I had uh some uh uh skin cancer, right? So they took it out and I had a um a procedure, reconstruction procedure at an outpatient facility with a plastic surgeon.
[CUSTOMER][NEUTRAL] Um, I don't know if you see if the claim was put in by you, by the doctor yet or authorized by you.
[AGENT][NEUTRAL] OK, so for this policy, we don't do prior authorization. You, they will go through your primary insurance. We only review it once your primary processes it and applies it to your deductible co-insurance or co-pay. So it has to go through them first before we get it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, OK. All right. So, so what, what do you cover at that point?
[AGENT][NEUTRAL] OK. So if it's anything rendered within an office setting, as long as it's due to sickness or injury, verification of coverage does not guarantee the payment of the claim. You do have up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's it.
[AGENT][NEUTRAL] That's it up to the $500 that we will pay out per day.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] All right, so if I, if I did a procedure.
[CUSTOMER][NEUTRAL] In an office and then I went into, I had to go to an outpatient procedure for uh a place to do the second part of the procedure. That's just one day, right?
[AGENT][NEUTRAL] That's just one day, yes.
[CUSTOMER][NEUTRAL] Right, OK, so it's $500 basically what I would get. If you go to the back to the doctor on a different day, they should pay it that day, so it's $500 for the Park Creek facility and then $500 for Doctor [PII], correct? Right, but, but it was on the same day. No, but you're going to Doctor [PII]'s on a different day. Oh yeah, that's true. So, so I would get 500 per each day then, correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] All right, OK. Now, did they send that to the facility or to you? So do I have to file the claim or does my doctor uh file it with you guys?
[AGENT][NEUTRAL] What they would do, normally the provider will submit it to us, but if they don't, then you have the option to submit it once it goes to your primary insurance.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you. You've been helpful. I appreciate it.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's OK. That's it. Thank you.
[AGENT][POSITIVE] Thank you so much for calling American Public Life. Have a great day.