AccountId: 011433970860
ContactId: 9e5c30e0-5b49-4426-8ddf-4f3f3bd7e1a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300510 ms
Total Talk Time (AGENT): 146098 ms
Total Talk Time (CUSTOMER): 124001 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/9e5c30e0-5b49-4426-8ddf-4f3f3bd7e1a1_20250131T19:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from HCA Florida Citrus Hospital. Um, I'm calling to find out about this indemnity plan for a patient who used it as his health insurance, but it's not health insurance. So I just need to know the breakdown of his plan, like what his responsibility is.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. Well, I can definitely help you with the plan coverage and may I have your, um, well, a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] and the policy number is 02583787.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], uh, date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Um, so let me see. So the policy has been active since [PII] and let me see what coverage you have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is just if he uh if he's like admitted into the hospital and confined, there's a daily um indemnity benefit of $30 a day. If there is an admission, um, the first occurrence, the policy will pay up to $1500 but that's the only coverage that he has for this policy.
[CUSTOMER][NEUTRAL] He is currently under observation. He's not inpatient, so this doesn't even apply, right?
[AGENT][NEUTRAL] Not until now, let me check for confinement. Sometimes it's
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Yeah, even for confinement, he has to be there for at least 24 continuous hours, so it wouldn't be able to come into play. Now, if he is admitted, then, you know, we can file, but for right now, he's not.
[CUSTOMER][NEUTRAL] So he has a one-time benefit of $1500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And he submits that claim to you, correct?
[AGENT][NEUTRAL] No, I, I mean, he can, but usually the providers file the claim.
[CUSTOMER][NEUTRAL] See, I have an indemnity plan, but I also have health insurance and my indemnity plan, I don't even give to the hospital. I just request the UBO4 and submit it myself.
[AGENT][NEUTRAL] I mean, well, yeah, you're in our business, but for like patients that don't know, yeah, the providers typically bills the claim and if some, for some reason they don't, then the patient can, um, but yes, this is a limited medical benefit, so it's not like a major insurance, but it is medical insurance, it's just limited to these benefits.
[CUSTOMER][NEUTRAL] It cost him $1500 to sign his name.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Like, uh, you know, this is not insurance, and I think they really think that they have insurance.
[CUSTOMER][NEUTRAL] This is
[AGENT][NEUTRAL] Yeah, if this is his only insurance, I mean, I don't know if this is the policy that he chose because there were other options. I, I mean, I don't know, but yeah.
[CUSTOMER][NEGATIVE] Yeah, I don't know either. I just feel bad because they hand it to us like it's a real insurance and it's, it's a real indemnity insurance, but it's not major medical and it says it right on the card, so.
[CUSTOMER][NEUTRAL] Um, OK, so where do we submit claims to? Do you do it electronically?
[AGENT][NEUTRAL] So it's
[AGENT][NEUTRAL] Um, you can mail it or you can send it electronically or you can fax it. Um, I can give you whichever you prefer or all three.
[CUSTOMER][NEUTRAL] OK, give me the facts uh for claims.
[AGENT][NEUTRAL] OK, so it's um 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And that's attention, APL claims department.
[CUSTOMER][NEUTRAL] OK, so I have [PII]. Is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And it's attention claims department?
[AGENT][NEUTRAL] APL claims department, mhm.
[CUSTOMER][NEUTRAL] Oh, APO
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, also, is there a reference for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Um, so that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate you.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APL. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.