AccountId: 011433970860
ContactId: 55441e4e-c8e2-4bbe-92c1-4db54b80557f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370859 ms
Total Talk Time (AGENT): 149613 ms
Total Talk Time (CUSTOMER): 140789 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/55441e4e-c8e2-4bbe-92c1-4db54b80557f_20250107T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, this is [PII] calling from the products of checking eligibility and benefits.
[AGENT][POSITIVE] OK, I can assist with that. Thank you, [PII]. May I please have your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it is [PII] and it is direct line extension.
[AGENT][POSITIVE] OK, thank you so much for that information, [PII]. And what is that policy number, please?
[CUSTOMER][NEUTRAL] The member ID just a moment.
[CUSTOMER][NEUTRAL] It is 02465467.
[AGENT][POSITIVE] Thank you so much. Let me just repeat that to you, [PII], just to make sure I have that correct in my system. I have that as 02465467.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much. verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, the member's name, it is [PII], and the date of birth it is [PII]. May I have your name, please?
[AGENT][NEUTRAL] Sure. My name is [PII]. My last initial is [PII], no problem, no problem.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again you're calling for eligibility and benefits for this member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, of course I can help you with that. Now she shows effective as of [PII] and this policy shows active as a supplemental medical policy.
[AGENT][NEUTRAL] And would you need inpatient or outpatient benefits today, please?
[CUSTOMER][NEUTRAL] It is for an outpatient service. Do you have primary as Medicare?
[AGENT][NEUTRAL] No, this will have to be a major medical.
[CUSTOMER][NEUTRAL] So could you please check whether the what is the primary insurance for this number?
[AGENT][NEUTRAL] Let me check to see if the information is available [PII], one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And of course to verify this information if it is available, you will need to contact the insured um I showed that the major medical is angle with the Cigna network or Cigna.
[CUSTOMER][POSITIVE] Thank you, I got it. OK, so may I have the plan name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, OK, I got it. Shall I have the plan name for this number for the current policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a Medlink supplemental policy.
[CUSTOMER][POSITIVE] Midli supplementary. Thank you.
[CUSTOMER][NEUTRAL] Do you have any group number for this plan?
[AGENT][NEUTRAL] I do that group number shows 21499.
[CUSTOMER][NEUTRAL] 21499. OK, could you please check for the plan type whether it is HMO PPO or EPO.
[AGENT][NEUTRAL] This is a supplemental medical policy.
[CUSTOMER][NEUTRAL] So it is med link supplemental policy, right? Medical policy, right?
[AGENT][NEUTRAL] Correct, a supplemental medical policy. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Do you follow any specific network?
[AGENT][NEGATIVE] There is no network.
[CUSTOMER][NEUTRAL] So shall I have the claims mailing address please?
[AGENT][NEUTRAL] Certainly, it is APL claims [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So we need to send the claims to American Public Life Insurance, right?
[AGENT][POSITIVE] Yes, [PII], that is correct.
[CUSTOMER][POSITIVE] Thank you. Thank you. You have got daughters, OK.
[CUSTOMER][NEUTRAL] Uh, I already have that. Shall we get into the benefits? I need physical therapy benefits for this number.
[AGENT][NEUTRAL] Please note verification of benefits provided does not guarantee payments. For outpatient benefits, we will pay up to $2000 for the calendar year for covered services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] I'd like to check the network status for this number. Just a moment.
[CUSTOMER][NEUTRAL] Does it under Signa network?
[CUSTOMER][NEUTRAL] Uh, because I like to just confirm the network status. Just I like to know whether the policies, whether the product is in network or out of data for the policy.
[AGENT][POSITIVE] I'm I'm sorry.
[AGENT][NEGATIVE] [PII], there is no network for this policy. Again, there is no network for this policy.
[CUSTOMER][NEUTRAL] OK, thank you. OK, so the load benefit amount is $2000 right?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] That is correct for the calendar year for covered services.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Thank you. Do you have any co-payment or co-insurance?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Do you have any deductible or out of pocket max?
[AGENT][NEUTRAL] There is no deductible for this policy.
[CUSTOMER][NEUTRAL] What is the, do you have any auto packet max?
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Do you have any out of packet maximum?
[AGENT][NEUTRAL] The max that we will pay to help with the major medical deductible co-pay or co-insurance is $2000 for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, I got it. So, so the number is covered 100%, right?
[AGENT][NEUTRAL] Again, [PII], we pay up to $2000 for covered services.
[AGENT][NEUTRAL] For outpatient
[CUSTOMER][POSITIVE] Yes, up to $2000 the number is 100% right, up to $2000.
[AGENT][NEUTRAL] We pay up until 2000 has been exhausted for covered outpatient services.
[CUSTOMER][POSITIVE] Thank you, I got it OK um.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, can you please check whether the number whether authorization is recorded for the service.
[AGENT][NEUTRAL] No pre-starts or pre-authorizations are required. This is a supplemental policy.
[CUSTOMER][NEUTRAL] So doesn't acquire right?
[AGENT][NEUTRAL] No pre-certs or pre-authorizations are required.
[CUSTOMER][POSITIVE] Thank you, I got it, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Thank you. Thank you for assistance. I hope I got all the details which I needed for this number. Shall I get the call reference number for this call whenever you are ready?
[AGENT][NEUTRAL] We do not provide call reference numbers, [PII]. However, you can use my name [PII] last initial [PII], and today's date. Anything else I can help you with, please?
[CUSTOMER][POSITIVE] Uh, no, [PII], I'm good from my end. Have a great day. Byeby take care.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks for calling Ael. Take care as well. Bye.
[CUSTOMER][POSITIVE] Thanks