AccountId: 011433970860
ContactId: 955ca66a-2d01-4084-92bc-b38d98c1ef82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338160 ms
Total Talk Time (AGENT): 157177 ms
Total Talk Time (CUSTOMER): 166235 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/955ca66a-2d01-4084-92bc-b38d98c1ef82_20250207T14:58_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, I have a question on my benefits. Um, I'm fixing to have surgery and um I called the registration, register's office at the hospital, and they were saying that, that they had called y'all and that there was no benefit amounts available. So I was like, no, that doesn't make sense. Let me just call. I just want to call to verify.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And, uh, your name is?
[CUSTOMER][NEUTRAL] Mhm. My name is [PII].
[AGENT][NEUTRAL] And Ms. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it's 01758742.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Awesome, thank you so much. Give me one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth, mail address and email address, please.
[CUSTOMER][NEUTRAL] OK, it's [PII] and it's [PII]. Uh email is [PII].
[AGENT][NEUTRAL] OK, thank you so much. And you said the provider told you that you didn't have benefits with us or you max benefits?
[CUSTOMER][POSITIVE] Yes, I've max benefits and I'm like, OK, so.
[CUSTOMER][NEUTRAL] Um, you had called, so my doctor, Doctor [PII], that's doing this, the surgeon, he called and so $1000 of that is going to get applied to their, their account or you know, so I only, I already took care of that anesthesiology is taken care of cause my my major medical, but the hospital said, no, you have none. I said, well, I thought with the hospital, they had, there was other benefits with that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm not sure.
[AGENT][NEUTRAL] OK. Um, and this is gonna be an inpatient or outpatient surgery? I'm assuming outpatient?
[CUSTOMER][NEUTRAL] Outpatient. Yes, ma'am, outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because you, I do show you have an outpatient benefit, uh, which pays up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So maybe that's already being met through the surgeon.
[AGENT][NEUTRAL] It could be. It depends on uh which claim we receive first, whether it's from the surgeon, anesthesiologist, or from the facility, but as of yet, it's still available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But that's it. There's no other.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there no other coverage just that?
[AGENT][NEUTRAL] Uh, just that for outpatient, yes, ma'am, on your policy. Well, the policy you have with us is a secondary supplemental plan. So after your primary is processed, if they apply anything towards your deductible, co-pay or co-insurance, that's what we pick up and pay up to that max, but I don't show you have any other coverage with us.
[CUSTOMER][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. I just want to, I just wanted to double check before I went and paid them cause they're like just pay us and then you could get reimbursed and I'm like, well, let me just make sure what it is, but I think the $1000 is gonna get picked up by the surgeon, so, um.
[AGENT][NEUTRAL] OK, and when I guess after you have your services and after primary insurance has processed the claim, uh, I don't know if you set up on our online service center, but we do have it to where you can submit the claim information through there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As opposed to mailing or faxing, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, I didn't hear that.
[CUSTOMER][NEUTRAL] OK, um, and it's just the American Public Life website and then I just create an account?
[AGENT][NEUTRAL] Uh yes, if you go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would select new user and then individual.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then from there you'll be able to set up a username and password and you can view your policy, uh, submit claim information, and you can check claim status from the site.
[CUSTOMER][NEUTRAL] Oh, perfect. OK. Now, so when I, when I have like regular procedures like, like I just had the MRI done and I had, you know, a CT done, how much of that is covered? Like how, what, what's the max on that?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, depending on the place of service, cause your policy is pretty much like place of service driven. If it's in an outpatient facility or imaging center, then it would just go towards that outpatient benefit, that 1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK, I got you, and then goes, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then, but if I was admitted into the hospital, um,
[AGENT][NEUTRAL] Uh, if you're admitted, that means if you're confined 18 hours or more, then it pays up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 200, OK. OK, perfect.
[AGENT][NEUTRAL] Yes, I am.
[CUSTOMER][POSITIVE] Alright well thank you and I'll set up that account and go from there I appreciate it.
[AGENT][POSITIVE] OK, and if you are welcome. If you have uh any errors or need any assistance, just give us a call back and we can help you with setting up.
[CUSTOMER][POSITIVE] OK, I will. Thank you so much. I appreciate it.
[AGENT][POSITIVE] You are welcome, Ms. [PII]. Thanks for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Yes ma'am you too bye bye.
[AGENT][NEUTRAL] Bye.