AccountId: 011433970860
ContactId: 9d032aa3-eaa1-4948-9001-5fe845487815
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281410 ms
Total Talk Time (AGENT): 96422 ms
Total Talk Time (CUSTOMER): 131687 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/9d032aa3-eaa1-4948-9001-5fe845487815_20250425T20:03_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] Uh yes, my name is [PII], and I was needing to check eligibility and benefits on a patient.
[AGENT][NEUTRAL] OK, may I please have a callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Uh, it shows 02300681. I think that's an 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits, is there a specific benefit you're calling in for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, he is having a surgery, uh, at an ambulatory surgery center at our facility, and I wanted to check. He says this is a supplement policy.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And thank you so much, [PII], for verifying the policy. You're calling in for outpatient benefits and eligibility. Verification of coverage does not guarantee the payment of the claim. For the policy, it is showing that it's currently active with the effective date of [PII]. For outpatient, the member has up to $1000 per calendar year.
[AGENT][NEUTRAL] That will go towards the primary insurance deductible, co-insurance or co-pay. This policy is for sickness and injury only. It will not cover any preventative or wellness. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK, uh, well, I have just some clarification. Are you saying they will pay up to $1000?
[AGENT][NEUTRAL] We will pay up to $1000 towards the primary insurance deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] OK and um is that for OK so I'm with the facility so who's ever claimed like the doctor's office.
[CUSTOMER][NEUTRAL] Um, whosever claim is in there, $1000 would go to whosever claim is in there first, and that's the max that is paid, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, now, and this does this payment go directly to the patient or to the facility or the provider who bills?
[AGENT][NEUTRAL] It's according to who submit the claim claim in first.
[CUSTOMER][NEUTRAL] OK, so it's not some of these plans they pay the patients directly, so.
[CUSTOMER][NEUTRAL] Uh, and not the facilities, and we don't do that, so, um, it will pay the facility or whoever directly, correct?
[AGENT][NEUTRAL] Yes, if the facility submits the claim in first, then that payment will go to the facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I had another question and I'm uh.
[CUSTOMER][NEUTRAL] OK, and then according to the card, the the claims go to the [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] can hardly read that [PII].
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] OK, and oh, are you able to tell me if the $1000 is still available?
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then, uh, I assume no authorization. You just since this is a supplement plan correct?
[AGENT][NEUTRAL] No authors required.
[CUSTOMER][NEUTRAL] OK, all right, and then do you give a call reference number for our call?
[AGENT][NEUTRAL] The call reference will be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][POSITIVE] OK, thank you so much for your time I appreciate it.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, [PII]. Have a great day and enjoy your weekend.
[CUSTOMER][POSITIVE] OK thank you you too.