AccountId: 011433970860
ContactId: 57b3b939-342c-43bb-9311-1f922aceb776
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 742940 ms
Total Talk Time (AGENT): 351208 ms
Total Talk Time (CUSTOMER): 292322 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/57b3b939-342c-43bb-9311-1f922aceb776_20250617T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] I'm calling to verify um eligibility. I need to verify if the member has um.
[CUSTOMER][NEUTRAL] Has, are they active for doctor's visits or, or do they have limited indefinity?
[AGENT][NEUTRAL] Uh, indemnity, I can see what kind of policy this is, uh, and the office visits are covered, um, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have policy number?
[CUSTOMER][NEUTRAL] It's 02124592.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so I'm showing this policy terminated [PII]. If you'll give me one moment though, I'll see if they have one that's active, it might just be a different policy number.
[CUSTOMER][NEUTRAL] No, I just need to verify this one. I called earlier, but I forgot to ask the questions about the hospital, yeah, she told me the effective date was [PII] and it ended [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, sure, so you were just wanting to see if they had uh offices that benefits while it was.
[AGENT][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] Yeah, and, and, and was the husband, was he on the account was the husband [PII], was he on the policy during those times too?
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Yeah, so, uh, we [PII] was the policy holder, uh, [PII] was the spouse, and then we have, uh, [PII] as.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So was [PII], was he on the policy during that time of coverage?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, was this, uh, for both of them are we looking for?
[CUSTOMER][NEUTRAL] OK, so he has, so he has the same, so he.
[CUSTOMER][NEUTRAL] No, no, no, he, so he has the same name, same coverage dates as [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. All right, so I just need to verify, did they, were they covered for doctor visits or hospital visits?
[AGENT][POSITIVE] Sure, sure, give me just a moment. I'm gonna pull up the policy um and check those benefits for you.
[AGENT][NEUTRAL] Bear with me just a moment, it's thinking about it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, there we are. I appreciate your patience. OK. And of course I will let you know verification of coverage is not a guarantee of payment for claims. So doctor's office visits, they had, um, they do have benefits for that. So each visit it did pay an indemnity amount of $75 per visit.
[AGENT][NEUTRAL] And that is going
[CUSTOMER][NEUTRAL] Um, hold on.
[AGENT][NEUTRAL] Maximum, I'm sorry.
[CUSTOMER][NEUTRAL] I mean, so, so, so they, I'm sorry, so you said they had doctor's visit?
[AGENT][NEUTRAL] So there's uh two separate that they have um they both pay 75%. There's a wellness benefit, so just a regular wellness exam, um, and then there's one regarding uh sickness. So if they went to the doctor because they were sick.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so they, they, they was covered for doctors visits. No, not, they weren't just limited just to go to the hospital, right?
[AGENT][POSITIVE] Oh yes, yeah, they do have uh the office visits absolutely.
[CUSTOMER][NEUTRAL] OK, so they was, so they don't have like a um.
[CUSTOMER][NEUTRAL] Cause on the, on the card it says limited benefit hospital and dent ee. So what does that mean?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, so the name of the plan is Hospital indemnity. That's just the name of this kind of policy, um, however, of course they all are very different this particular one, it is an optional writer that they had on the policy to be able to cover office visits as well. The indemnity saying limited is just it is limited as to what is and is not covered.
[CUSTOMER][NEUTRAL] OK, so they, so, so they was.
[CUSTOMER][NEUTRAL] OK, so they, so that's just the plan name that they have, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so they, they are covered everything like with the, going to the doctor and the hospital, so they have, they're covered like everything. That's what I'm trying to verify. cause I guess the, the plan, the plan threw me off on the card when it said limited benefit.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, you're, yes, these kinds are confusing anyway, but yes, and again some of the members, if you see another patient that has that they may not have this writer that covers office visits, um, like the baseline is pretty much just going to be the um hospital like confinement and things like that. However, this individual, they opted for these writers that do offer uh doctor's office visits.
[CUSTOMER][NEUTRAL] OK, OK. That's for both [PII] and [PII]. They had the same plan, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Um, and you.
[AGENT][NEUTRAL] They're both listed under this policy.
[CUSTOMER][NEUTRAL] OK, you said if they did, what was the amount you gave me like per day or something? What was?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, so per visit it pays a maximum benefit amount of $75.
[CUSTOMER][NEUTRAL] A day?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and so if they go to the um like hospital, what does that do they get a certain amount or something the ICU or something?
[AGENT][NEUTRAL] OK, so I'll just go ahead and tell you that uh this their benefits are very, very limited so I'll just go ahead and give you a breakdown. They have a hospital consignment benefit, so if you know they had to stay inpatient, um, intensive care and coronary care benefit, wellness and diagnostic benefit, um.
[AGENT][NEUTRAL] Let's see, annual first occurrence hospital benefit, so that's just like a lump sum and then uh surgical and anesthesia benefit and then of course the office visit benefit that's going to be the extent of what they're covered for.
[CUSTOMER][NEUTRAL] OK, so I don't have like a certain amount a day or something like that.
[AGENT][NEUTRAL] So, well, if it's, uh, again, if they were confined the daily excuse me, daily indemnity benefit was $100 per day of being confined in the hospital.
[CUSTOMER][NEUTRAL] OK, $100 per day.
[AGENT][NEUTRAL] Correct. uh, intensive care and coronary care, yeah, that's hospital confinement. Uh, intensive care and coronary care is $400 daily indemnity.
[CUSTOMER][NEUTRAL] If they had to go to the hos if
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but you said it was covered, but you said they, they was covered on everything, so I wouldn't have to worry about that when I'm adding this policy because I would add it like a regular major medical policy because you said they, they cover everything, doctor's visits and everything, right?
[AGENT][NEUTRAL] Um, I wouldn't say everything. It really does what I just read you, that was the breakdown of their benefits, and again it's that indemnity amount, so it's not going to be like traditional major medical where it's a certain percentage or anything like that. It's just a set dollar amount per covered procedure or office visit.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And also, can I, where do you, can you tell where the um where they submit claims at? Do you have the claims address for that?
[AGENT][NEUTRAL] Sure, um, yeah, I've got a mailing address, fax number, and a payer ID I can give you.
[CUSTOMER][NEUTRAL] What's the address that y'all submit claims to?
[AGENT][NEUTRAL] Sure, that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that zip code is uh.
[CUSTOMER][NEUTRAL] OK, and that's where y'all get.
[AGENT][NEUTRAL] Oh, do, do you have it? No, you're fine. Did you need that zip code?
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] It's um is the zip code [PII].
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, OK. I just, OK, because on the card, it has, um, cause I have an ID card for them and the ID card, it has to make claims to [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Is it a multi plan?
[AGENT][NEUTRAL] In [PII]?
[CUSTOMER][NEUTRAL] This is, yeah, yeah.
[AGENT][NEUTRAL] Yeah, so this is a part of a um multi plan. I know it's very confusing so.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] But yes, that [PII] address is ours, that's American Public Life.
[CUSTOMER][POSITIVE] OK, OK, OK, even though that [PII] address is on the card, OK, I got you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And y'all, and y'all are, what is American public life, right? Public life.
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK, do you have, um, you have the group name or group number for the ID number that I have.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Let me check that. Give me just a moment.
[AGENT][NEUTRAL] Uh yes, OK, so that group number is 70056.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then that group name is management.
[AGENT][NEUTRAL] Analysis
[AGENT][NEUTRAL] And the utilization.
[CUSTOMER][NEUTRAL] OK, so I can just shorten it up. MAU MAU. Y'all use MAU? OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] I think that'd be fine. We have it spelled out, but I think that'd be fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got you. OK.
[CUSTOMER][NEUTRAL] Alright um.
[CUSTOMER][NEUTRAL] Yeah, I think those were um the questions that I needed to verify and I called when I called earlier, she told me the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The RX vendor was Purbea, what is it? P H A R M A V I A L.
[AGENT][NEUTRAL] Uh, Farmerville, Farmerville.
[CUSTOMER][NEUTRAL] Palmerville, yeah, that's, yeah, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and you can't tell if they had any dental coverage or anything like that, right?
[AGENT][NEUTRAL] Um, if they did, that would be a different policy. Let me see.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, they did have a dental policy, um, looks like that effective date and term date were the same as the hospital indemnity, so, um, [PII].
[CUSTOMER][NEUTRAL] Do you know who their dental was with?
[AGENT][NEUTRAL] Um, I'm not sure, usually, um, I mean.
[AGENT][NEUTRAL] Let's see, we don't keep like information regarding providers just they're with these kinds of policies they could take them anywhere, so it's possible that you know if they've filed claims they could take it to multiple different providers.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so y'all can only thing y'all can verify is that they did have dental coverage but you can't see who the vendor is.
[AGENT][NEUTRAL] No, um, I mean again if they had claims it was probably from multiple providers.
[CUSTOMER][NEUTRAL] OK, you just can't see it, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Alright, alright, well thank you for verifying that for me.
[AGENT][NEUTRAL] Of course did you have any other questions for me?
[CUSTOMER][POSITIVE] Um, no, ma'am, that was it. Thank you.
[AGENT][POSITIVE] Alright, yeah, thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Alright you too thanks bye.
[AGENT][POSITIVE] Thank you. Bye-bye.