AccountId: 011433970860
ContactId: 943df624-a7d4-44ec-8da3-fba4c2c66b78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435049 ms
Total Talk Time (AGENT): 105799 ms
Total Talk Time (CUSTOMER): 231278 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/943df624-a7d4-44ec-8da3-fba4c2c66b78_20250411T18:57_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] Hi [PII], my name is [PII]. Um, I have [PII] from my insurance my, from my employer. They, my employer also sent me um the APL as well. However, I never really knew how to use it. Um, I don't think we really, I just know I got a card and they were like.
[CUSTOMER][NEUTRAL] It was the second insurance or something like of that nature. Um, so my colleague spoke with one of your representatives today, um, to like tell her how this is how it works with having APL or whatever, um, and I realized that I wasn't, well, with that being said, I wasn't using it to its potential that I'm supposed to be using it too. Um, so I wanted to give you guys a call because um I've had a different things that I've been to the um.
[CUSTOMER][NEUTRAL] Doctors or hospital for um in the past year itself, um, or in the past couple of months itself that I've had APL so I wanted to reach out to you to see if I could get you guys to adjust those claims or look at them.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello? Oh, sorry.
[AGENT][NEUTRAL] Yes, may I have the policy number?
[CUSTOMER][NEUTRAL] Um, for APL or uh policy number, um, I see the group number and I see the er number.
[AGENT][NEUTRAL] Yes, I'm needing the benefit certification number.
[CUSTOMER][NEUTRAL] OK, um, 02562832 M as in Mary, L as in Larry.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] And I do need to verify your date of birth and to also get a callback number.
[CUSTOMER][NEUTRAL] [PII], be careful. [PII] is on the end.
[CUSTOMER][NEUTRAL] [PII], um, this number here ending in [PII] is a good callback number.
[AGENT][NEUTRAL] OK, you will have to verify that callback number for me please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I do need to verify the mailing address that is listed on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then we do have an email address, could you verify that to make sure it's correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you were calling, were there any claims that were submitted in or have those claims not been submitted?
[CUSTOMER][NEGATIVE] Um, they've been submitted to Florida Blue, but I never knew that I even had an account with you all online. Like I never created um an actual account with you guys until again today when my co-worker told me we were supposed to create an account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but I've already had things that have been filed with Florida Blue, um, but not you all.
[AGENT][NEUTRAL] Do you have a data service?
[CUSTOMER][NEUTRAL] Um, I have a few dates, um, let's see what you have.
[AGENT][NEUTRAL] May I have one, please?
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] Or to be again.
[CUSTOMER][NEUTRAL] My claims.
[CUSTOMER][NEUTRAL] OK. I'm trying to go back to possibly the most recent.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Um, I can give you one for [PII].
[AGENT][NEUTRAL] Yes, yes, we have some claims in for [PII].
[AGENT][NEUTRAL] For inpatient stay.
[CUSTOMER][NEUTRAL] OK, and what
[CUSTOMER][NEUTRAL] OK, so if anything applied to for the any of the claims that's been submitted, I think the [PII] is possibly is definitely not the most recent, um.
[CUSTOMER][NEUTRAL] Even for that one, was anything applied to that one from APL?
[AGENT][NEUTRAL] Yes, for the data service of 13125, it is showing that we processed and made a payment up to $5000 to the provider and once we made that payment, that is the maximum amount that could be paid out.
[CUSTOMER][NEUTRAL] OK, and that's just for that service or in general?
[AGENT][NEUTRAL] In general for the year [PII] for the inpatient stay, that's the maximum amount that we would pay out.
[CUSTOMER][NEUTRAL] OK, and so the max amount has already been paid out for that day or for that service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK, so there's nothing else that could happen this year that you guys would actually pay out for?
[AGENT][NEUTRAL] Not for the 131 and for inpatient.
[CUSTOMER][NEUTRAL] OK, I'm trying to understand it. So if I were to go to the doctor today and um I'm having to, or there's a pay after the actual service, so nothing will be paid out or I wouldn't be able to get anything from you all with that service?
[AGENT][NEUTRAL] Is this an office visit, outpatient?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] Which one office or outpatient?
[CUSTOMER][NEUTRAL] Um, I'm an office visit, outpatient or an office visit for the most part. I don't really have any other surgeries or hospital stays going, um, so it'll be a doctor's appointment.
[AGENT][NEUTRAL] OK, let me check those benefits for you.
[AGENT][NEUTRAL] And in regards to the office visits and or procedures, verification of coverage does not guarantee the payment of the claim. If you have an office visit fee, which is the co-pay, we do not cover that copay, but if you have something rendered within an office setting, you do have up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you, um, could you let me know what is the most recent claim that you have for date on your end?
[CUSTOMER][NEUTRAL] Cause I'm assuming that since I haven't report, I didn't even report that to you guys so I'm [PII]ng that you have an integration with um Florida Blue where they send over my claims to you guys as well.
[AGENT][NEUTRAL] Normally sometimes the primary insurance will submit the EOB over, they do a crossover.
[CUSTOMER][NEUTRAL] OK, um, Florida didn't tell me that. OK, so that's nice to know. Um, OK, so for the most recent that I have on my end, um, and I'm just trying to see, well, that probably makes sense actually. OK, um, I guess that's all of my questions that I have.
[AGENT][POSITIVE] OK, well, I do wanna thank you so much for calling American Public Life [PII]. You have a great day. Yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you bye.