AccountId: 011433970860
ContactId: 5933ed64-d7b8-47ca-9b6c-828953cd406e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496500 ms
Total Talk Time (AGENT): 198886 ms
Total Talk Time (CUSTOMER): 226660 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/5933ed64-d7b8-47ca-9b6c-828953cd406e_20250422T12:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII], hello good morning my name is [PII]. How are you?
[AGENT][POSITIVE] Good morning.
[AGENT][NEUTRAL] I'm fine. You said your name is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah correct.
[AGENT][NEUTRAL] Yes, you will. How, how
[AGENT][NEUTRAL] Can I help you today?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Yes, I'm doing good thank you I'm pretty much calling on behalf of a patient um they.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just wanted to verify if their American Pub Life um supplement is active and if there's any uh you know, amount available to be applied if possible.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility, but you really, do you need benefits also or just eligibility?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I guess the benefits in terms of uh because this patient has a um an inpatient visit today and then they provided the American Pub life information so I'm verifying uh yeah the benefits.
[AGENT][POSITIVE] OK, yes, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It'll be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Alright, so the policy number is 022.
[CUSTOMER][NEUTRAL] 164.
[CUSTOMER][NEUTRAL] 96.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lulu.
[CUSTOMER][NEUTRAL] And then the number 8.
[AGENT][NEUTRAL] OK, thank you very much one moment please while I get the member's information pulled up.
[AGENT][NEUTRAL] And [PII], how do you spell your first name?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today.
[AGENT][NEUTRAL] It will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Alright, uh her last name is [PII], first name is [PII], and the date of birth is [PII] I mean [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said that you were needed an inpatient in-hospital benefit. Is that correct, not outpatient?
[CUSTOMER][POSITIVE] Correct, yes, inpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this policy, the inpatient calendar, your maximum benefit for cover person is $1000.
[AGENT][NEUTRAL] With no inpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] And uh let's see and
[CUSTOMER][POSITIVE] Perfect, no deductible.
[AGENT][NEUTRAL] And for this calendar year as of now she has not used any.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to their primary insurance.
[AGENT][NEUTRAL] When the claim is submitted to [PII], we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal in which you should be able to check our claim status and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you for
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK, so yeah, I have the primary insurance already verified, um, so you're saying for inpatient stay they have a $1000 maximum, no deductible, uh, the full amount is available.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then uh I'm guessing for um the rest of the information I I can relate to the patient because you were saying that for claim submission submission.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, there needs to be record of an explanation of benefits from primary insurance.
[AGENT][NEUTRAL] Yes, sir. Yes, because this policy is designed to help them with co-pays, deductibles, and co-insurance amounts of coverage services. So we do have to have the primary EOB along with the claim for us to review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect perfect OK so all right.
[CUSTOMER][NEUTRAL] Alright so name was [PII].
[AGENT][NEUTRAL] I did and my name and today's date will also be your call reference number.
[CUSTOMER][NEUTRAL] [PII] and then [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright perfect so I'll explain I'll I'll tell that to the patient in terms of the renting because I know that um.
[AGENT][NEUTRAL] In a certain
[CUSTOMER][NEUTRAL] I can provide them with the um.
[CUSTOMER][NEUTRAL] An information in terms of uh.
[CUSTOMER][NEUTRAL] What is it called? I gotta give them a phone number to patient financial services so that, oh, I guess you just need the benefits the the explanation of benefits because I was gonna give them a receipt for the pain I mean for what they're getting done, but I guess that.
[AGENT][NEUTRAL] Yes, because
[AGENT][NEUTRAL] Yes, we will have to have a claim form or the UBO4 from the facility that includes the diagnosis and procedure codes, as well as the, uh, you know, a detailed EOB from the primary showing any amounts applied to co-pay, deductible or co-insurance.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So patient.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] Are you all gonna be filing the claim with for the member?
[CUSTOMER][NEUTRAL] Financial services. So, um, I'm pretty much just the, the registration. I, I work the account so I'm gonna, I'm gonna input everything in there with, uh, you know, the claim information where it gets submitted to and then I'm gonna relay this information to the patient so that you know because they um.
[AGENT][NEUTRAL] I got you, OK.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] They have to wait for the surgery to be done and then the account to be discharged so that they can be provided that information.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so you all will not be filing the claim, the member will.
[CUSTOMER][NEUTRAL] Um, pretty much, um, we're gonna have a claim on our side.
[CUSTOMER][NEUTRAL] Which that that department you know is gonna contact the patient and everything too to help you know uh get this submitted correctly.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, but that's pretty much everything I needed help with, uh, [PII], thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome. So if that is all that I can help you with today, [PII], it was my pleasure in speaking to you and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Perfect, you too, [PII] bye bye.
[AGENT][POSITIVE] Yes, thank you so much. Uh-huh. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye.