AccountId: 011433970860
ContactId: 64b47269-f245-4e1c-8ad2-502d529b0637
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362779 ms
Total Talk Time (AGENT): 205717 ms
Total Talk Time (CUSTOMER): 120206 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/64b47269-f245-4e1c-8ad2-502d529b0637_20250124T13:57_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], good morning. Um, I'm [PII], I mean, um, I'm calling because I'm gonna do a, a, a hand surgery and I provide my doctor, uh, the APL to cover my deductible. And, and they say that they first they uh bill my insurance and then they, I don't know how this works, and then the insurance has to bill you.
[CUSTOMER][NEUTRAL] Oh, I don't know how that works, and then they told me that I have to pay before my surgery. But I never done that before, so I'm just calling to see what can I do, if I pay the doctor, you guys reimburse me the money, or do I have to tell the doctor to call you guys director directly, or, I mean, can you help me?
[AGENT][NEUTRAL] OK. What I can, I can help you. What's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. And what's your policy number, Ada?
[CUSTOMER][NEUTRAL] OK, it's um let me see here. It's 971-141.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ada, can you verify your date of birth, your mailing address, and your email address, please?
[CUSTOMER][NEUTRAL] Yeah, my, um, date of birth is [PII]. My email address is [PII], and my address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that your email is uh your [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so there's no period in between your first and last name?
[CUSTOMER][POSITIVE] No, no, everything is good.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. And so.
[AGENT][NEUTRAL] Um, you're correct in saying that you have the major medical coverage and they'll send it to your major medical carrier first. Uh, and then generally, the provider will then also send it to your, to American Public Life to pay a secondary, um.
[AGENT][NEUTRAL] You also stated or asked whether they should contact us to verify your benefits. The answer is yes, um, and that way we can tell them what your outpatient benefit is and perhaps not for sure because it's up to the provider they may not require that you pay anything upfront, but that is that part is solely dependent upon each provider's office, OK? We have no control over that but in the event that they do, they do require you to pay out of pocket, you can submit the claim to APL yourself um however there are.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] 3 documents that we require from you after the service has been provided.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After or before?
[AGENT][NEUTRAL] After
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And so you may wanna write this information down as far as what's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, please.
[AGENT][NEUTRAL] OK, so we'll need a copy of a completed APL claim form. Uh, that claim form can be downloaded from our website which is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have a med link policy so you'll search for the Medli claim form.
[CUSTOMER][NEUTRAL] The name form. OK.
[AGENT][NEUTRAL] Uh huh, and there is a download button to the right of Metin claim form. Just click the download button and then you can print the claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's one document. The second document that we require, um, is the itemized bill.
[AGENT][NEUTRAL] So, after the surgery has been done, you know, they'll generally prepare an itemized bill for you. Um, and so you would let them know that you need to request their itemized bill to submit to your insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And uh more than likely you'll have a a facility charge and then your surgeon's charge and maybe some ancillary charges to go along with it.
[AGENT][NEUTRAL] Um, however you choose to, to handle it if you want to, uh, you'll have to call each of those uh entities, so you'll need to contact the billing office at the hospital and request the their itemized bill and then you'll need to contact the surgeon's office and request a copy of their itemized bill.
[CUSTOMER][NEUTRAL] OK, so it's to the hospital and the doctor, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then the third document, since we're secondary, uh, you'll need to reach reach out to your primary insurance or you could perhaps download their explanation of benefits from their website. We need their explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That coincides with the date of service for, for the hospital and then we'll also need the one for your surgeon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, um, if it, I mean, I have a write it, write it down, but if I need help, can I call again?
[AGENT][POSITIVE] Oh, absolutely.
[CUSTOMER][POSITIVE] OK. OK. Well, thank you very much for your help.
[AGENT][NEUTRAL] You're welcome, but you may wanna first try the route of asking them if they would be willing to submit the information on your behalf, and then they can also reach out to us and then we can verify your benefits and let them know how both policies work hand in hand.
[CUSTOMER][NEUTRAL] OK. So they, the, the doctor's office can call you, uh, directly, directly to the APL. OK, OK, thank you very much for your help.
[AGENT][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] All right, Ada, did you have any other questions?
[CUSTOMER][POSITIVE] No, that's it, thank you. I really appreciate it.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome. Thank you for calling. Thank you, thank you for calling APL. Have a good day as well.
[CUSTOMER][POSITIVE] OK, bye-bye. Have a nice day. Bye-bye.
[CUSTOMER][NEUTRAL] Oh, OK. Bye-bye.