AccountId: 011433970860
ContactId: 9ac72557-9650-43de-a557-ea432fc550c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256298 ms
Total Talk Time (AGENT): 100174 ms
Total Talk Time (CUSTOMER): 120889 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/9ac72557-9650-43de-a557-ea432fc550c8_20250318T16:47_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]. How's your day going?
[AGENT][POSITIVE] Going good. How about you?
[CUSTOMER][NEUTRAL] It's going well, thank you. Um, I'm reaching out because, um, I'm getting a sonogram, uh, an MRI this [PII]. Um, I was able to provide all the information and APL's information as well, my policy number. Um, they told me that APL was only covering 250. Now when I go to pay the full amount, which is 1100, um, how does that work?
[AGENT][NEUTRAL] OK. May I have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, sorry. Um, policy number 2491451.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And could you verify your date of birth with me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do need to verify the mailing address and email address and to get a callback number.
[CUSTOMER][NEUTRAL] Sure. Um, so, mailing address would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, the callback number is [PII].
[CUSTOMER][NEUTRAL] And the email [PII].
[AGENT][POSITIVE] And thank you so much, [PII] for verifying your policy and you was calling in regards to some benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was that for outpatient?
[CUSTOMER][NEUTRAL] Uh yes, it's for outpatient.
[AGENT][NEUTRAL] OK, so for your policy, I do see verification of coverage does not guarantee the payment of the claim that you do have up to the $250 per calendar day that we will pay out towards your primary insurance deductible co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] OK, um, now when I make the full payment, um.
[CUSTOMER][NEGATIVE] so what, um, so the 250 won't even, it's not even uh guaranteed for this procedure.
[AGENT][NEUTRAL] So if they over if they charge you $1000 which is towards your deductible coinsurance or copay, when the provider submit the claim to the primary, they will receive an EOB.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Then the provider will then submit the claim over to us with the primary EOB and if you still have that $250 available at that time, if nothing else come in after for that procedure, we will pay that $250 and then that will leave a balance of that $750 if it's the $1000.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK, no, yeah, I, I, I just need clarification because this is my first time doing this kind of procedures, um, with, uh, with, um, with medical insurances, so I, I just want to, I just want to know like, OK, so if it was covered the 250, just pay the $750 and then the 250 I guess would come back to my card.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] If, if we pay the, if the provider submits the bill to us, we're gonna pay that $250 to that provider.
[CUSTOMER][NEUTRAL] Uh, OK, OK, OK, got it, got it, got it.
[CUSTOMER][POSITIVE] OK, no, that sounds good. um, thank, thank you so much, [PII]. That's pretty, that's pretty much um the clarification I needed.
[AGENT][NEUTRAL] OK, but you may wanna ask them if they're going to submit the bill to see if that 250 is going to be deducted off your responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I should contact my, my primary, um, yeah, primary provider.
[AGENT][NEUTRAL] The provider, the provider.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that sounds good thank you so much again, [PII].
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life [PII] have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye.