AccountId: 011433970860
ContactId: 8df4e982-0b55-4be1-86f6-82864b3fe899
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485890 ms
Total Talk Time (AGENT): 182244 ms
Total Talk Time (CUSTOMER): 235188 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/8df4e982-0b55-4be1-86f6-82864b3fe899_20250603T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII]. Did you say your name was Easy? I just wanna make sure.
[AGENT][NEUTRAL] Um, it's [PII], um, no problem.
[CUSTOMER][POSITIVE] Oh, easy. I'm sorry about that. Easy. OK.
[CUSTOMER][NEUTRAL] Well, hi, hi, [PII]. I'm calling because my mother just had her knee replaced and her day is gonna be overnight. So I was wondering if, I was wondering what APL will be able to cover for her.
[AGENT][NEUTRAL] OK, yes, sir. I can see if I can assist you with benefits. Uh, first, could I get a callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course, the callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I have the group number.
[AGENT][NEUTRAL] Um, if you have the card, do you see where it says inpatient certificate number or inpatient benefit number?
[CUSTOMER][NEUTRAL] Uh, oh, I see it in hospital benefits er number.
[AGENT][NEUTRAL] OK. Yes, sir. What's that?
[CUSTOMER][NEUTRAL] And then an outpatient benefit certain number. OK, um, the first number is 022.
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] 833 ML 7
[AGENT][NEUTRAL] OK, thank you. Now, please verify her name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found her in the system, but unfortunately, since you're not on the policy, I'm unable to give you any information. If she's available to give you permission to speak for her, um, I'll be happy to further assist you.
[CUSTOMER][POSITIVE] Perfect. Hey mom, um, they, they asked if you're available to speak and just say that you give permission for
[CUSTOMER][NEUTRAL] Hello. It's on speaker. Hello? Hello? Hi, how are you?
[AGENT][NEUTRAL] Um, yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. This is I'm good. Um, this is EV with American Public Life. Do you give your son permission to speak on your behalf so that I can um give out benefit information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And could you please verify your name and date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you, ma'am. That's all the information I need and I'll further assist your son.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. No problem.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Yes, sir. Hello. And so you need to verify inpatient benefits?
[CUSTOMER][NEUTRAL] Bay.
[CUSTOMER][NEUTRAL] Oh, I, I need to make sure cause I, I ran into a little bit of a snag with um our doctors in United Health, so I wanted to talk to you about it.
[CUSTOMER][NEUTRAL] Um, we are here overnight. Uh, we are here, we, we got here at [PII], we will be here until at least [PII] or [PII] tomorrow.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's not longer. I think we're gonna be here until the afternoon tomorrow, um, but for some reason.
[CUSTOMER][NEUTRAL] The way that our, our doctors writing it and the way that it's, it's being processed with our insurance is outpatient.
[CUSTOMER][NEUTRAL] I'm a little confused since we're staying overnight.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] You have to suck. You have to inhale, mom.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Um, but long story short is.
[CUSTOMER][NEUTRAL] We don't know uh what APL will cover.
[CUSTOMER][NEUTRAL] Because even though it literally is inpatient, for some reason on the paper trail, they're calling it outpatient.
[AGENT][NEUTRAL] OK. Yes, sir, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on the policy was [PII] and the policy is still active. And for inpatient benefits, we cover up to 5000 per calendar year.
[AGENT][NEUTRAL] And that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. So as your secondary insurance, um, we'll go by whatever is submitted um by the primary insurance. So if they set it up as inpatient, we'll cover up to $5000 and if they set it up as outpatient, we'll cover up to $500 per day for again, the co-pay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So what happens if it's literally inpatient, but they want to file it as outpatient because United Health won't pay the hospital unless it's outpatient.
[CUSTOMER][NEUTRAL] Because United Health is the primary, which is who they're filing with.
[AGENT][NEUTRAL] Yeah, unfortunately, again, as your secondary insurance, we, we go by the primary carrier.
[AGENT][NEUTRAL] Because, um, we go by their explanation of benefits once they.
[CUSTOMER][NEUTRAL] So I need to take it up with United Health.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Cause it was explained to me by a doctor that they want to do it as inpatient, but if they do, United Health is just gonna deny the claim entirely.
[AGENT][POSITIVE] Oh wow.
[AGENT][POSITIVE] Yeah. I apologize.
[CUSTOMER][NEUTRAL] Do you see what I mean though, it's like a catch-22 because I'm, I'm really not mad at the doctor at all. Like, I understand he needs to protect his hospital, I get it. But also,
[CUSTOMER][NEUTRAL] It seems
[CUSTOMER][NEGATIVE] Kind of wrong given that she is staying the night and she is admitted into a hospital, so she should be considered inpatient.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah. Again, we go by what they send us. Yeah.
[CUSTOMER][NEGATIVE] We're kind of at a loss for what to do.
[CUSTOMER][NEUTRAL] Do you, I guess, in your experience in the field, do you have, have any advice on who I may, who I should talk to or how I should handle maybe speaking United Health?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, try to speak with someone in management to see why aren't they covering inpatient benefits.
[AGENT][NEUTRAL] Cause I thought most insurance plans, uh, especially would cover inpatient. I've never heard of that.
[CUSTOMER][NEGATIVE] They're, they're literally not allowing the doctors to call it inpatient, even though it is inpatient.
[AGENT][NEUTRAL] Wow. Yeah, cause normally, if someone is admitted over 18 hours, um,
[AGENT][NEUTRAL] Yeah, that's considered inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I've had plenty of doctors who, who are my friends, uh, have told me that too. So that, that's why I'm kind of confused. I'm just like, hey, I don't mean to be rude cause like I really do respect the medical profession and like the healthcare industry, but also this seems wrong, so what do I do?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, try to see if you can speak um to someone in management to further assist you with that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] No, that is all.
[CUSTOMER][POSITIVE] But, but thank you for your time, E.
[AGENT][POSITIVE] OK. All right. Well, I thank you.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.