AccountId: 011433970860
ContactId: 89dfc55a-3587-4a15-a72b-a2bc5000f228
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 607929 ms
Total Talk Time (AGENT): 161320 ms
Total Talk Time (CUSTOMER): 137450 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/89dfc55a-3587-4a15-a72b-a2bc5000f228_20250429T19:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ACO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. My name is [PII]. I'm a case manager at Sharp Memorial Hospital. Um, I'm calling regarding, uh, a patient, one of your members, um, he has
[CUSTOMER][NEUTRAL] American Public Life Insurance. So we're trying to see if he has any um skilled nursing facility or acute rehab benefits.
[AGENT][NEUTRAL] OK, so skilled nursing facility, and what was the second one?
[CUSTOMER][NEUTRAL] Uh, or acute rehab or even he will need eventually home health also. So we're just trying to see because our, our acute rehab facility said he doesn't have any rehab benefits, so I just wanted to confirm if that's across the board and also for skilled nursing facility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, I can look into the benefits for you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02495893.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And then can you verify his first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK and then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, give me just one moment to look into his benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee payment, just a verification of coverage. So it looks like he does have an intensive care slash coronary care unit.
[AGENT][NEUTRAL] So that means
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It means that that's a part of the hospital which is segregated from the rest of the hospital's facility.
[AGENT][NEUTRAL] Um, it covers room and board, and specialized registered nurses and other nursing services.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right. I mean, he has regular hospital coverage, right? I mean, that's for the ICU, but he has regular, he's he's not in the ICU right now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, I'm trying to see if there's a nursing facility on here.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sorry, I'm just reading through this. I wanna be positive what I tell you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me see if rehab is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And rehab is a little different from skilled nursing facilities, so wanna see because I we sent out referrals and there's no accepting so I'm wondering if he doesn't have both.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yes, so it doesn't look like.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Acute rehab, home rehab, or skilled nursing facility is covered under his policy.
[CUSTOMER][NEUTRAL] Is the hospital stay covered?
[AGENT][NEUTRAL] Yes, so he does have a daily hospital confinement benefit.
[AGENT][NEUTRAL] And that is $50.
[AGENT][NEUTRAL] And then he also has an annual first occurrence hospital confinement.
[AGENT][NEUTRAL] And that is $500.
[CUSTOMER][NEUTRAL] What was the, can you say the same thing, he has a daily.
[AGENT][POSITIVE] Yes, a daily hospital confinement benefit.
[CUSTOMER][NEUTRAL] Confinement, like you're confined into an area, is that what you're saying?
[AGENT][NEUTRAL] Yes, so he's just staying there for more than 18 hours.
[CUSTOMER][NEUTRAL] So you, when you say $50 that means is that his co-pay or what does that mean?
[AGENT][NEUTRAL] So APL doesn't cover copays?
[AGENT][NEUTRAL] It just covers like his his office visit?
[CUSTOMER][NEUTRAL] What is the $50?
[CUSTOMER][NEUTRAL] But you said daily hospital confinement, you said $50.
[AGENT][NEUTRAL] Yes. So we will pay $50 a day if he is in the hospital confined.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] So he.
[CUSTOMER][NEUTRAL] What, what, what was, what was the second thing you said? I mean, the rooms are like $10,000 a day just for the room, um, but what, what was the second thing you said after that?
[AGENT][NEUTRAL] Yes. OK. And he also has an annual first occurrence hospital confinement, and that's $500.
[CUSTOMER][NEUTRAL] That that you guys will pay towards the hospitalization.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] annual first incurrence hospital confinement. So basically the only coverage is $500 plus $50 a day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is this uh like a, a plan through his work or?
[CUSTOMER][NEUTRAL] I don't know if you know that.
[AGENT][NEUTRAL] Let me see if he's on a group.
[AGENT][NEUTRAL] Yes, so it's it is through a group, so it would be from his work.
[CUSTOMER][NEUTRAL] And there's no expiration for this, um.
[CUSTOMER][NEUTRAL] I guess it doesn't matter. Um, so no home health, no skilled nursing, and no ERU.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK. Does it say you have any other details about the plan?
[AGENT][NEUTRAL] I see.
[AGENT][POSITIVE] So, for this plan, he does have a wellness and a diagnostic test benefit.
[AGENT][NEUTRAL] So, it looks like for diagnostic testing, if you had any of that done or a wellness exam.
[CUSTOMER][POSITIVE] OK. All right. um, thank you so much for your, for your time. I appreciate it and the information, [PII].
[AGENT][POSITIVE] Yeah, of course. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much.
[AGENT][POSITIVE] OK, yeah, of course, have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] Alright, bye.