AccountId: 011433970860
ContactId: 82728f7e-744e-4fea-bd43-84ef03e60932
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658900 ms
Total Talk Time (AGENT): 301349 ms
Total Talk Time (CUSTOMER): 214725 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/82728f7e-744e-4fea-bd43-84ef03e60932_20250102T21:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. I'm calling from Advanced dermatology. I'm trying to get benefit information please on a patient.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and that's the direct line.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh [PII], um that's spelled [PII]
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number please?
[CUSTOMER][NEUTRAL] Uh, I have.
[CUSTOMER][NEUTRAL] Does it start with a D?
[AGENT][NEUTRAL] OK. Can you give me the policy number that you have?
[CUSTOMER][NEUTRAL] OK, on the card it has the D number 435-08500.
[AGENT][NEUTRAL] OK, and you're calling for benefits for him. So what I'm gonna need to do is I'm gonna need to transfer you on over to IMA um let me give you that phone number just in case the call gets disconnected, you'll have it.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] OK, hold on for just a moment because I called 90s, 90 degree benefits 90 degree benefits transferred me to you for APL because they say you are um their provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right. So let me see if I can.
[CUSTOMER][NEUTRAL] And now you wanna transfer me to IMG?
[AGENT][NEUTRAL] IMA
[AGENT][NEUTRAL] Um, which is 90 degree benefits normally they take, yeah, normally they take the um, the calls that um have the policy numbers that start with a D, but if they transferred you back to us, then I'm gonna go ahead and try to find out the.
[CUSTOMER][NEUTRAL] Oh, I
[CUSTOMER][NEUTRAL] They say no.
[CUSTOMER][NEUTRAL] Yeah, yeah, they transferred to me you because they
[CUSTOMER][NEUTRAL] They said that um they only do, deal with preventative. They say the card is split. One part does this, the APL does the other part for medical benefits. Um now,
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] There is an ID number also in here um that was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 2174923
[AGENT][NEUTRAL] OK, let me look that number up because that sounds closer to one of our policy numbers so let me check on that one for you real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] If, if not then I'll try to search him by his name and we'll we'll make sure you get some help.
[CUSTOMER][NEUTRAL] Yeah, because that's what she told me she said yeah she said that you can probably look it up by his name because I asked if she could give me the correct ID number. She said you should be able to pull it up by the name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, ma'am, and I do, I, I did find him, um, and his policy is active. His effective date is [PII], and this is just to verify benefits. It's not a guarantee of payment. This policy is a hospital indemnity policy. It helps with hospital admission. um, he has.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A calendar year benefit amount for um.
[AGENT][NEUTRAL] Hospital admission one day per calendar year of $500 and then he has a hospital confinement benefit of 30 days per calendar year that pays at $50 each day for 30 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, he's coming in, in for an office visit with the dermatologist.
[AGENT][NEUTRAL] OK, alright, let me check. I'm gonna pull his com.
[CUSTOMER][NEUTRAL] So we're, we're not a hospital.
[AGENT][NEUTRAL] OK, let me pull up his, his certificate and look at it and see if uh uh if uh office visits are covered for outpatient on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a moment because the computer has to pull it in and it's a.
[AGENT][NEUTRAL] Long policy, so I'll have to look through it and look for office visits for you. I just want to let you know it's just gonna take a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate that. Thank you.
[AGENT][POSITIVE] You're so very welcome. No problem at all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he has um
[AGENT][NEUTRAL] Outpatient accident and sickness treatment benefit for an emergency room, urgent care center, or a physician's office, that's $50 per day, a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that what he pays a $50 copay?
[AGENT][NEUTRAL] No, that's what we pay.
[CUSTOMER][NEUTRAL] OK, that's what the insurance pays, so anything over the $50 is the patient's responsibility.
[AGENT][NEUTRAL] And um this is just to verify benefits. It's not a guarantee of payment. Um, I'm gonna see if it says anything about dermatology at all.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] I'm not saying dermatology, but it should be under that office visit, uh, the physician's office of 50 $50 per day for 4 days a year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And it's for the outpatient is for accident or sickness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And he don't, um, there, he don't have any tax benefits on this policy, right? Uh, laboratory benefits, they don't have any on this policy, right?
[AGENT][NEUTRAL] Let me check and see.
[AGENT][NEGATIVE] No, I do not see any lab laboratory benefits on this policy for his schedule of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, do we have, uh, does he have any surgery benefits on this policy?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, he has for accident or sickness surgery benefit in a hospital or hospital outpatient for $250 per day and maximum of 1 day per calendar year.
[AGENT][NEUTRAL] Um, a free-standing outpatient facility.
[AGENT][NEUTRAL] A surgery center or surgery in a physician's office. The physician's office surgery is $125 per day, a maximum of 2 days per calendar year.
[CUSTOMER][NEUTRAL] OK. And anything over that is the patient's responsibility. OK. Um, can you tell me whether or not, um, have they used any of those visits?
[AGENT][NEUTRAL] Let me look and see for the year of [PII] what's been used.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Nothing has been used this year so far.
[CUSTOMER][NEUTRAL] Because this, this is a
[CUSTOMER][NEUTRAL] OK, so it's not plain um.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Where do the claims go to?
[AGENT][NEUTRAL] The claims are gonna go to if you want to um.
[AGENT][NEUTRAL] Send it in electronically. I can give you the payer ID number which is 60801.
[AGENT][NEUTRAL] You can also fax a claim in and I can give you that fax number.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Uh, no, they, they will have.
[AGENT][NEUTRAL] Ma'am, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] [PII] and then we also have a claims mailing address if you want to mail them in to APL claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the and the ID number is 2174923?
[AGENT][POSITIVE] Yes ma'am, that's correct that's yeah for APL yes ma'am.
[CUSTOMER][NEUTRAL] That is the correct ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, what does APL stand for?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK, American Public Life.
[CUSTOMER][NEUTRAL] Let me see if they got it loaded up under there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, they have it up on that one.
[CUSTOMER][NEUTRAL] Uh, and you said the pay ID is 60801?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that is what I'm putting it up on there. Can I get a reference number please?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I appreciate your help very much, [PII]. Thank you.
[AGENT][POSITIVE] You're so very welcome, Ms. [PII]. I hope you have a blessed rest of your day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye bye.