AccountId: 011433970860
ContactId: 3f0d1c26-d99c-4766-8443-6493253a07ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266619 ms
Total Talk Time (AGENT): 135205 ms
Total Talk Time (CUSTOMER): 73632 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/3f0d1c26-d99c-4766-8443-6493253a07ef_20250619T14:42_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm supposed to have surgery the [PII] of this month.
[CUSTOMER][NEUTRAL] I need to see how much of a gap of the the my gap insurance is gonna cover my uh deductible.
[AGENT][NEUTRAL] I can take a look at that for you. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, the policy number you're calling on?
[CUSTOMER][NEUTRAL] Um, I think it's 0261877777.
[AGENT][NEUTRAL] And if you could verify your uh name and your full name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK. Thank you so much for verifying uh your policy. And you said you are calling to see what the benefit is for outpatient. Is this an outpatient surgery or inpatient?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It it's outpatient.
[AGENT][NEUTRAL] OK, so please be advised verifying benefits is not guaranteed payment.
[AGENT][NEUTRAL] Uh, so it looks like for your.
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it looks like for outpatient benefits, uh, your policy pays up to $1500 a calendar year.
[AGENT][NEUTRAL] Uh, that, uh, could
[CUSTOMER][NEUTRAL] That's what?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] That's what the my gap insurance covers of my deductible?
[AGENT][NEUTRAL] Then let me make sure there's 2 amounts here. Let me.
[CUSTOMER][NEUTRAL] I thought it was I thought it was.
[AGENT][NEUTRAL] Let me see, hold one moment, let me just make sure.
[CUSTOMER][NEUTRAL] I thought it was up out.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. Uh, so I do apologize for that. It does look like your policy for outpatient pays up to $4500 a calendar year.
[CUSTOMER][NEUTRAL] 4500. OK, perfect. So how do, how does this work? I'm gonna need it to pay for my, uh, patient surgery the 24th and Baptist Hospital.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, so what you want to do is when you, uh, prior to your surgery, uh, they should request uh insurance information and you want to let them know.
[CUSTOMER][NEUTRAL] Well, well, that's what I'm wondering. I'm sorry, let me, let me you. My, my surgery is next Tuesday and nobody's called me yet about it. I just received a, uh, text message from [PII] saying that I owe 4, it's gonna cost $4700 for the surgery.
[CUSTOMER][NEGATIVE] And um but nobody's contacted me I guess that's what's going on. I mean how does it work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I would reach out to the facility to make sure that they are aware that you do have a secondary insurance. That's what you want to let them know, uh, and you want to provide them with your, uh, American public life information, and then at that point, what they should do is give us a call to verify your benefit. We'll let them know you have a benefit of $4500 a calendar year.
[CUSTOMER][NEUTRAL] That's what I'm, yeah.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Also let them know you have that full amount available so at that point they should submit to your primary, I guess your primary is applying that $4000 to your deductible.
[AGENT][NEUTRAL] And they'll send us the explanation.
[CUSTOMER][NEUTRAL] 4000
[AGENT][NEUTRAL] And they'll send us the explanation of benefits uh to pick up that the balance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK, thank you very much for your help. Have a nice day.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That that was my question. Thank you bye bye.
[AGENT][POSITIVE] Oh, OK. Have a wonderful day. Thank you for calling APO. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.