AccountId: 011433970860
ContactId: 5085c85d-fc37-4ab4-ac11-7ece71293ef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320920 ms
Total Talk Time (AGENT): 125664 ms
Total Talk Time (CUSTOMER): 180394 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/5085c85d-fc37-4ab4-ac11-7ece71293ef2_20250313T17:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. I'm sorry, good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good afternoon. My name is [PII], and I wanted to get some information about um the benefits that I've received um between A from ACL, um, specifically, um,
[CUSTOMER][NEUTRAL] Been in the hospital, being in the hospital, um.
[CUSTOMER][NEUTRAL] How does that work? How do we apply how do we.
[CUSTOMER][NEUTRAL] How does that work I guess. What, what do you cover?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, Ms. [PII], what is your policy number? I can verify your benefits for you.
[CUSTOMER][NEUTRAL] The group number is 17198.
[AGENT][NEUTRAL] No, ma'am. Do you see a policy number or policy certificate number or may say in hospitals or outpatient benefit number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I have this benefit certificate number.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] On the card?
[CUSTOMER][NEUTRAL] in hospital benefit if c cert number, is that what you're wanting?
[AGENT][NEUTRAL] Uh, yes, ma'am. Either in hospital or outpatient, either one is fine.
[CUSTOMER][NEUTRAL] OK, in hospital says 0228.
[CUSTOMER][NEUTRAL] 6573 ML 7
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, ma'am. And Ms. [PII], verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Uh, it's, uh,
[CUSTOMER][NEUTRAL] [PII], [PII]. The email is [PII].
[AGENT][NEUTRAL] OK, thank you so much. And Ms. [PII], you say you're calling to verify what type of benefits you have on the policy?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] Specifically what did to pay if I'm in the hospital?
[AGENT][NEUTRAL] OK, let's see. Well, with this policy, we are your secondary. We help with your major medical deductible, co-pay, and or co-insurance, not a guarantee of payment, just a verification of your coverage. You have an inpatient benefit that pays up to $5000 per calendar year, and inpatient is if you're confined 18 hours or more.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and what if, um, I have prescription, a high prescription in the hospital? Will you pay that, include that in the 5000?
[AGENT][NEUTRAL] Well, it's just for charges in patients. So if you're receiving prescriptions and let's say it's not from an actual pharmacist, but you're inpatient in the hospital and on your facility charge, it lists that you receive any kind of medication, then it would just go towards uh prime or your um benefit.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 7000.
[CUSTOMER][NEUTRAL] OK, alright, and um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then how do we do we submit that claim? Do we just fill out the form or go to the website and fill out the form?
[AGENT][NEUTRAL] Well, if you're submitting a claim, you would need to fill out the claim form and we will need a copy of the itemized hospital bill showing diagnosis and procedure codes and the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the, and the uh insurance explanation, OK.
[AGENT][NEUTRAL] Yes, ma'am, or uh you can give the information to the provider and they can submit a claim. So either you can or the provider can submit the claim.
[CUSTOMER][NEUTRAL] Oh, you mean like the hospital directly can submit it to?
[AGENT][NEUTRAL] They can, yes, ma'am. Uh, you can, when you give them your primary insurance information, you can give them our information as secondary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Making, OK, great. That would make it a little easier. We can do that. Um, I'm actually not calling for myself. I'm calling for my boss.
[AGENT][NEUTRAL] It, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she, but you know, if we have the same policy, so I was, was giving my of my name because her husband was just recently in the hospital and she's like, how are we gonna claim this? I'm like, I think it's 5000 but let me find out for sure.
[CUSTOMER][NEUTRAL] And we'll, and then I'll help her get this, get it all put together, um, so, OK, that's what we needed to know, um, OK, because he had, he had, um, quite a, you know, 1015 days in the hospital and then he had um a very large um prescription of medications that was very high as part of the hospital bill.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So that's why I was like, oh, I know it doesn't cover prescriptions, but if it's part of the hospital bill, it will, right?
[AGENT][NEUTRAL] It could, yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, well, great, that's what we needed to know, um, we will, um, get all that information together then and get back to you.
[AGENT][NEUTRAL] All right. Well, is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] I think that that was very helpful thanks so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Thanks for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.