AccountId: 011433970860
ContactId: 8c7533f0-ebe6-4d0e-87bb-e3f23c1ab692
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327500 ms
Total Talk Time (AGENT): 129606 ms
Total Talk Time (CUSTOMER): 116278 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/8c7533f0-ebe6-4d0e-87bb-e3f23c1ab692_20250509T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, good afternoon. My name is [PII]. I have a, um, policy with you guys and I'm wondering about a
[CUSTOMER][NEUTRAL] Specific question about how I go about um taking out a claim I'm having a uh.
[CUSTOMER][NEUTRAL] A surgery here in a couple of weeks and um they said I would have to pay out of pocket and then uh possibly file a claim. Just wanted to know what that process looks like.
[AGENT][NEUTRAL] OK. May I have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Policy number is 025.
[CUSTOMER][NEUTRAL] 813
[CUSTOMER][NEUTRAL] 13.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So is your first name [PII]?
[CUSTOMER][NEUTRAL] Last name.
[AGENT][NEUTRAL] Last name, OK.
[CUSTOMER][NEUTRAL] Person [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And could you verify your mailing address, please?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mailing address [PII].
[CUSTOMER][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Thank you, and it does look like we have an email address on file. Could you verify that for me please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, that's not the one we have in the system.
[CUSTOMER][NEUTRAL] OK, there's my work email [PII].
[AGENT][NEUTRAL] Yes, now do you want that one on file or do you want your personal?
[CUSTOMER][NEUTRAL] My personal, please.
[AGENT][NEUTRAL] OK, and could you repeat that one for me so I can enter that in the system for you?
[CUSTOMER][NEUTRAL] Yep, it is [PII] the initial last name [PII], [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, I will get that entered in the system for you and I'm pulling that information up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And thank you so much for verifying your policy. You're calling to see how to submit a claim. You do have the option, once it goes to your primary insurance, you will receive an EOB showing your patient's responsibility. Once you receive that, you have the option to submit that EOB in.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And a documentation which is a discharge paper or some type of doctor's note that has the diagnosis code listed on there.
[AGENT][NEUTRAL] And once you submit that in, we will receive it and review it and if it's eligible to be processed, then we will make the process and make a payment.
[CUSTOMER][NEUTRAL] Alright, submit, uh, submit the EOB with discharge papers.
[CUSTOMER][NEUTRAL] And where would I be submitting that is it um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The information on the back of the card.
[AGENT][NEUTRAL] You can submit it via fax, mail, or the secured portal, and that secured portal should be listed on your card and you would just set up a username and password.
[CUSTOMER][NEUTRAL] The portal OK and you said if it qualifies it would be reimbursed um.
[CUSTOMER][NEUTRAL] How, how do I go about knowing if you know.
[CUSTOMER][POSITIVE] What, um, the, the surgery I have planned will be qualified with the procedure.
[AGENT][NEUTRAL] OK, do you, is this for inpatient, outpatient or an office setting?
[CUSTOMER][NEUTRAL] Uh, outpatient
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is done within an outpatient facility?
[CUSTOMER][NEUTRAL] Um, they do accept my insurance. Um, it's a, a urology facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the outpatient verification of coverage does not guarantee the payment of the claim. You do have up to $3150 max for your outpatient that will go towards your primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It does not cover any preventative or wellness. Is there anything else that I can assist you with today, Irene?
[CUSTOMER][NEUTRAL] Mm you said it doesn't uh.
[CUSTOMER][NEUTRAL] It doesn't include preventative care only if it's sickness or
[AGENT][NEUTRAL] Injury.
[CUSTOMER][NEUTRAL] Or what?
[CUSTOMER][NEUTRAL] OK, 173, got it.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.