AccountId: 011433970860
ContactId: 89095ed0-8fba-4949-a2f8-ae20f7645836
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415019 ms
Total Talk Time (AGENT): 198722 ms
Total Talk Time (CUSTOMER): 235229 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/89095ed0-8fba-4949-a2f8-ae20f7645836_20250404T15:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, good morning. Um, my name's [PII]. I'm the primary insured. My employ myself and my spouse are insured, and I, he was recently in the hospital. They would not, they want to take the secondary insurance or, you know, the gap insurance, but they won't take it because my car does not have a member ID on it.
[CUSTOMER][NEUTRAL] Um, I didn't know it if it was my the guy was kind of nasty to me on the phone. I don't know if it's my so if it was my husband's Social Security or what it is, but he was real nasty, and he says we can't take it. I can do that until you have a member ID. And I said, OK. So he suggested that I call you guys. Oh, he was so after I waited 33 minutes on the phone. Um, so can you help me with that? I have the group number. I have all the other stuff, but there's no mem member number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] OK, sure. I can assist you with that. No problem. All right. You're welcome. And let me have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][POSITIVE] OK [PII], thank you.
[CUSTOMER][NEUTRAL] Mhm I'm actually I'll uh I'm actually on my office line but my cell is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, perfect. Thank you. And what is the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] The policy number is 17198. 0, I'm sorry, that's group number the uh um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have a payer ID is that what you want?
[AGENT][NEUTRAL] No, it's gonna be probably the numbers in the bottom where it says outpatient cert number.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so uh there's an inpatient and outpatient number.
[AGENT][NEUTRAL] You can give me either or.
[CUSTOMER][NEUTRAL] Which one would you like?
[AGENT][NEUTRAL] Yeah or
[CUSTOMER][NEUTRAL] OK, 022.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 865-564 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, let me have that one more time. It kicked me out. I'm sorry.
[CUSTOMER][NEUTRAL] OK, 022.
[CUSTOMER][NEUTRAL] 86564.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 7.
[AGENT][NEUTRAL] OK, here it is. All right. And for security, I need your date of birth, mailing address and email address on file.
[CUSTOMER][NEUTRAL] OK, uh, my date of birth is [PII]. Um, my email address is probably my [PII]. Um, my mailing address is [PII].
[AGENT][NEUTRAL] OK. So we have your regular email, your personal email [PII].
[CUSTOMER][NEUTRAL] OK, yeah, it's [PII].
[AGENT][NEUTRAL] Perfect. Thank you. All right, Ms. [PII]. So, um, the member ID is the same as the policy number, which is the one you just provided to me. Is he hospitalized or is it, it's just an in and out?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] He, he was in, he was in the hospital for 11 days, um, and, um.
[AGENT][NEUTRAL] The inpatient, OK.
[CUSTOMER][NEUTRAL] Yeah, and they said that there was uh my accountant, she thought that there was a $5000 hospitalization pay uh benefit on this. I don't know if that's true, so.
[AGENT][NEUTRAL] OK, let me check the inpatient benefits for you. One moment. Let's see.
[AGENT][NEUTRAL] All right, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. All right. And let's see.
[CUSTOMER][NEUTRAL] Right, sure.
[AGENT][NEUTRAL] Yes, this one has a calendar year maximum of 5000 per cover person per calendar year. Um, so it's gonna be um inpatient. It's gonna fall under the inpatient benefit. Um, so you're gonna give them the inpatient cert number, which is the same number you gave me just, uh, it's an ML I think 7 if I'm not mistaken.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then, and then for the additional like doctor, so the hospital bill is like $3800 or whatever and I know it's not guarantee of payment and then I have like other the doctor's billing separate like another like $3000 of the doctor's billing separate it can I, can I get, I can give the doctor's offices the secondary insurance as well?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, you can, but if the facility is higher and they submit their claim before, then the other one will be denied. Um, but they can always send it. We'll pay the first one we get first.
[CUSTOMER][NEUTRAL] Well, the, the doc the, the doctor's office, the doctor's office is separate from the hospital. They bill separately.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah, but it was for the same time, correct? The same time that he was there hospitalized.
[CUSTOMER][NEUTRAL] What I, what I want, what.
[CUSTOMER][NEUTRAL] OK, so I'd wanna do the I'd wanna do the hospital one first, correct?
[AGENT][NEUTRAL] Um, I, I imagine so, um, because it's just $5000 for the whole remaining time that he was there for the whole 11 days that he was there, we'll cover $5000. So if there's any charges from the doctors or any separate charges, um, then, um, we're just going to pay the first one we get. So if we pay the doctors by the time we get the facility, we're not gonna have that amount, so it's gonna pay less.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, but if, if the doctors is only 1200 and the hospital is, I mean if the doctors is 1200 and the hospital is 3000, would you pay both of them as long as they were under 5000 or is it just one claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. No, as long as it's under 5000 or at 5000, we'll pay up to 5000, that's all. So, yes, if one is 3000 and the other one is 1500, then yes, it will be paying both, OK?
[CUSTOMER][POSITIVE] OK, OK, great.
[CUSTOMER][POSITIVE] OK great all right sweetie thank you very much for your help I really appreciate it.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it, thank you very much.
[AGENT][NEUTRAL] OK. You're welcome. Thank you for calling ATU. Uh-huh, go ahead. Yeah, yeah, yeah, go ahead, go ahead. Yeah. Mhm.
[CUSTOMER][NEUTRAL] Oh, wait, I have one more question. I have one more question. Does this have a, does this have a policy number? Do, do I need a policy number or?
[AGENT][NEUTRAL] The policy number is the certificate number. It's the same number.
[CUSTOMER][NEUTRAL] OK, because somebody told me that we had a policy number of 2286564 on this, is that right or no?
[AGENT][NEUTRAL] 2286564. That is the policy certificate number you provided to me in the beginning. It's the same one in the bottom of the card. Yes, it's OK, it's OK.
[CUSTOMER][POSITIVE] Oh sorry yeah OK got you OK all right sweetie thank you thank you very much.
[AGENT][NEUTRAL] It's all right. You're welcome. Is there anything else, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that's it thank you very much.
[AGENT][POSITIVE] All right. You're welcome. You have a good day. Have a good weekend. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] Bye bye you too bye.
[AGENT][POSITIVE] Thank you.