AccountId: 011433970860
ContactId: 5360bf82-162a-4071-94c8-9ab4674fd421
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376320 ms
Total Talk Time (AGENT): 157961 ms
Total Talk Time (CUSTOMER): 123892 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/5360bf82-162a-4071-94c8-9ab4674fd421_20250604T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I was just trying to get some uh insurance verified for medical, but.
[CUSTOMER][NEGATIVE] It wasn't an option. It only gave me the option of dental.
[AGENT][NEUTRAL] May I have your name, please?
[CUSTOMER][NEUTRAL] Uh yes, it was [PII].
[AGENT][NEUTRAL] And really, may I please have the policy number?
[CUSTOMER][NEUTRAL] It's 02013247.
[AGENT][NEUTRAL] And it's 02013247. May I please have a callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII] and it's no extension.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] And you're calling in for benefits, is there a specific benefit you're calling in for?
[CUSTOMER][NEUTRAL] I guess so I do have a list of benefits. I have a couple of kids and then the rest are just general. Do you want me to list them?
[AGENT][NEUTRAL] OK, we don't, we don't go by codes. We go by if it's an office setting, outpatient, inpatient.
[CUSTOMER][NEUTRAL] Oh, OK, well, it's the office setting. Like how do y'all cover after the primary? Like is it gonna cover 100% after?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Is it for the office visit or just a procedure running within an office setting?
[CUSTOMER][NEUTRAL] Uh, office visits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm pulling that information up for you.
[CUSTOMER][NEUTRAL] Like a specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm pulling it up for you now.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And in regards to this policy, verification of coverage does not guarantee the payment of the claim. This policy is showing currently active with the effective date of [PII]. For the office visit fee, the member does not have that benefit for the co-pay for the fee, but for any procedure that is rendered within that office setting, the member does have up to $7000 per calendar year.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That $7000 will go towards the primary insurance deductible, co-insurance, or co-pay for the procedure.
[AGENT][NEUTRAL] This policy is only for sickness and injury. It will not cover any type of preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] So is the $7000 what that's not, so it's just the $7000 per year that they can spend and it's gonna go towards the deductible for the primary?
[AGENT][NEUTRAL] It will go towards the deductible coinsurance or co-pay for the primary insurance. That is just for the office procedure only.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] Hm, OK, sorry, that's, it's a little confusing. Hold on one second.
[CUSTOMER][NEUTRAL] Because they're here right now, so I just wanna make sure I'm clear of what you're saying, so just give me one second.
[CUSTOMER][NEUTRAL] Hey SC, are you busy?
[CUSTOMER][NEUTRAL] Have her on the phone right now and they're here and it's secondary and I'm not really understanding what she's saying. Will you listen to it.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that, uh, that again? How it would cover as a secondary to, uh, Blue Cross Blue Shield Primary?
[AGENT][NEUTRAL] OK, who am I speaking with?
[CUSTOMER][NEUTRAL] This is SB the office manager.
[AGENT][NEUTRAL] OK, as I previously stated in regards to this member's policy, they do not have the office visit benefit rider, but for procedures that is rendered within an office setting, the member does have up to $7000 per calendar year in which that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy only covers sickness and injury. It will not cover any preventative or wellness.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, you did say that that was only for surgical procedures?
[AGENT][NEUTRAL] Sickness or injury and it only covers procedures rendered within an office setting.
[AGENT][NEUTRAL] It does not cover the office visit fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, give me 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and um and there's no deductible or out of pocket for the plan at all?
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK. We're not considered their major medical.
[CUSTOMER][NEUTRAL] So it's just
[AGENT][NEUTRAL] This is a supplemental or gap. So we don't have it, as of right now, this member does not have a deductible, co-pay or co-insurance with us. You would check with the primary.
[CUSTOMER][NEUTRAL] And then like
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and um I guess that was everything I need if I could just get a reference number.
[AGENT][NEUTRAL] Yes, for the reference, it will be my first name [PII], last initial of [PII] in today's date. And do you need me to spell my first name for you?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK. First name is spelled [PII]
[CUSTOMER][POSITIVE] Alright thank you ma'am.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great rest of your day, R.
[CUSTOMER][NEUTRAL] You as well bye.