AccountId: 011433970860
ContactId: b260520e-aec1-42c0-9c23-aa66f506355e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 850700 ms
Total Talk Time (AGENT): 358860 ms
Total Talk Time (CUSTOMER): 342349 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/b260520e-aec1-42c0-9c23-aa66f506355e_20250506T15:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII] and billing. How are you?
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][NEUTRAL] I'm good, um, so I have a group on the line who's calling about, uh, an employee that has questions about the copay for their med link, um, and like the, um, what it covers and stuff, and if the copay should be what they're saying, would you be able to help with that?
[AGENT][NEUTRAL] Mhm, what's the policy number?
[CUSTOMER][NEUTRAL] Uh, I don't have the policy number. It's the group admin that's calling, um, and the group is 21657.
[AGENT][NEUTRAL] Give me one moment. I forgot how to look up a group.
[AGENT][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] EMTL
[AGENT][NEUTRAL] They don't have a policy? What is it?
[CUSTOMER][NEUTRAL] Uh, EMPL and Lion for the group.
[AGENT][NEUTRAL] A M P A.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, see, I always look different. It's something else cause it's, it's another screen. [PII], is it, let me see if it's G R O U P.
[AGENT][NEUTRAL] It's something where they showed a group number but then.
[CUSTOMER][NEUTRAL] Let me do you want me to ask her for.
[AGENT][NEUTRAL] I can get a policy number from him.
[CUSTOMER][NEUTRAL] Do you want me to ask her for a policy number?
[AGENT][NEUTRAL] I can get one from him. What's the name?
[CUSTOMER][NEUTRAL] OK, her name[PII] [PII]
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh she's already verified and her callback number is the one she's calling from and the one that's on the group, the [PII] yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, well you can send over and I'll be able to assist you. Thank you and have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks. Goodbye.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, how are you doing, [PII]?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][POSITIVE] I'm great, thanks for asking. My name is [PII] and I'll be assisting you today. Is there a policy number that you can provide me with like your policy number to verify the benefits for you?
[CUSTOMER][NEUTRAL] A policy number OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] We this is one of our employees, it's policy 02141849.
[AGENT][NEUTRAL] Thank you. And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And she is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Is normal there with you now?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can I speak with her?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, just a second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello [PII]. How are you doing?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I'm well thank you. What can I do for you?
[AGENT][NEUTRAL] My name is [PII]. I'm an agent at American Public Life. I need you to verify your identity for me. Could you verify your mailing address for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the email address that well we don't have one for you. Could you verify your date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said that your mailing address is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Was there a different address when you signed up?
[CUSTOMER][NEUTRAL] And it's a unit
[CUSTOMER][NEUTRAL] Oh no, no, I've always been there.
[AGENT][NEUTRAL] So when I get down and helping you with your benefits, I'm gonna transfer you to customer service so they can change your um mailing address. It looks like they have the the the [PII] it's not on there. It's something else. We have [PII], so probably was a typo or something.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, no, no, no, it's [PII], OK, OK.
[AGENT][NEUTRAL] Um, and you're calling in regards to your benefits and you want to verify your office visits?
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Well, yes, because.
[CUSTOMER][NEUTRAL] This is what's happening um when I.
[CUSTOMER][NEUTRAL] When I go to the office of the surgeon.
[CUSTOMER][NEUTRAL] They're billing me $130 per visit.
[CUSTOMER][NEUTRAL] So I wanna know, does the gap cover any of the cost or I, I have the AvMed but we also have your gap insurance if it's $130 what is the gap insurance paying? They didn't pay any of it. I paid the full $130.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the date of service because there's, I'm not seeing a claim on file. What is the date of service?
[CUSTOMER][NEUTRAL] Well, I went twice. I went in March and I, I don't have the exact dates. I went on March, oh, I wanna say the [PII] maybe, and then I went again about a week ago. I don't know the exact date though. She doesn't see a claim, no.
[AGENT][NEUTRAL] So I have dates and services for [PII]. It shows you had an ER visit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I did, yes, the ER visit. I wasn't charged in the ER, but the following, not the following day, maybe two days later, I went to the surgeon's office to check the knee. I didn't get billed the first time, but on the second visit, I got billed $130.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] I'm not showing any claims on file.
[CUSTOMER][NEUTRAL] So I'm wondering.
[CUSTOMER][NEUTRAL] OK, she's not showing any claims on file, only the ER visit, mhm.
[AGENT][NEUTRAL] So when you go to the doctor [PII], are you giving them your primary and your secondary insurance card?
[CUSTOMER][NEUTRAL] Both of them, yes.
[AGENT][NEUTRAL] If I'm not showing you don't have any claims on file, but let me let you know what your benefits are.
[CUSTOMER][NEUTRAL] We gave both.
[CUSTOMER][NEUTRAL] So they don't
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So with your benefits with office visits?
[CUSTOMER][NEUTRAL] You know different.
[AGENT][NEUTRAL] So the office.
[CUSTOMER][NEUTRAL] Let me put you on hold real quick, hold on for me one second, hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, OK, so you're gonna tell me what now? what my benefits are?
[AGENT][NEUTRAL] Yes, let me give you your your benefits for um office. So the office visit itself is not covered, but the treatment received in the office say like if a procedure is done, any type of treatment provided to you while you're at that office visit, it falls under your treatment router which falls under your outpatient benefits of $7550 per calendar year.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer of the policy's coverage, so the office visit itself would not be covered, but the treatment received in the office would be covered. However, if they, but they still have not submitted a claim.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Cause we don't know if you got treatment received in it while you was at the office visit or is it just simply an office visit?
[AGENT][NEUTRAL] Then the claim may be denied, but the treatment received is covered under your policy, and they haven't sent any claims in. Let me see if they've called to verify your benefits.
[CUSTOMER][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Um, it's [PII]. Um, I'm here with [PII]. She's listening as well.
[AGENT][NEUTRAL] Mhm. Nobody called the verifier.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The co-payment
[CUSTOMER][NEUTRAL] The co-payment is is you do not cover the copayment, is that what it is?
[AGENT][NEUTRAL] We don't cover the office visit, no, not for the office visit, just the treatment received in the office.
[CUSTOMER][NEUTRAL] And the office visit is equal to a copayment, right?
[AGENT][POSITIVE] Right, that is correct.
[CUSTOMER][NEUTRAL] OK, and what about physical therapy?
[AGENT][NEUTRAL] That falls under her outpatient benefits.
[CUSTOMER][NEUTRAL] It's the same
[CUSTOMER][NEUTRAL] Outpatient benefits?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I was billed $100. OK, because she had a co-payment of $100.
[AGENT][NEUTRAL] See they're not I'm not the only claims that I've discussed with her is the ones that we have on file. I don't see any claims from anybody else in regards to any other services.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, but, uh, the co-payment that she had to give to physical therapy, you wouldn't cover that.
[AGENT][NEUTRAL] Physical therapy is considered as outpatient, so her physical therapy will be covered under her outpatient benefits. However, as I just expressed, there are no claims on file.
[CUSTOMER][NEUTRAL] They don't have a claim yet. OK, OK, so she's what.
[AGENT][NEUTRAL] They have not submitted any claims here on her behalf.
[CUSTOMER][NEUTRAL] Right, so what you're saying that she's not supposed to be paying anything?
[AGENT][NEUTRAL] No, I'm not, so I'm not, we're the insurance company. I'm not sure how they charge at the provider's office because they may want their money up front and they may not deal with secondary insurance companies. However, all I could tell her is suggest that she make sure that she give them both of her cards because she has a secondary insurance because I don't see any claims on file besides the ones that I mentioned to her about.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, but in general if you go to an outpatient, um, physical therapy type of thing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You're supposed to cover everything?
[AGENT][NEUTRAL] Her policy covers physical therapy.
[CUSTOMER][NEUTRAL] Even if they
[CUSTOMER][NEUTRAL] Physical the 100%.
[AGENT][NEUTRAL] No, I can't say it's gonna be 100%. It's just gonna be whatever the whatever went towards her deductible co-pay or co-insurance amount for physical.
[AGENT][NEUTRAL] Whatever the patient's responsibility.
[CUSTOMER][NEUTRAL] OK, that that's where we don't understand.
[CUSTOMER][NEUTRAL] Uh, because she had to pay a co-payment of $100.
[CUSTOMER][NEUTRAL] Is that part of the deductible?
[AGENT][NEUTRAL] She don't have a deductible here at American Public Life. I'm not sure what she has with a primary cause I'm not affiliated with it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It sounds like she's not giving them the secondary insurance card.
[CUSTOMER][NEUTRAL] Yeah, she she said she did.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. Well, they're not submitting any claims here on her behalf for physical therapy.
[CUSTOMER][NEUTRAL] Mm, OK, and.
[AGENT][NEUTRAL] She may wanna reach out to them to verify that they act in the billing department to verify that they actually have both of her insurances.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] She can call them on a conference call while I'm on the phone with her, but she would have to call them. I can't call them.
[CUSTOMER][NEUTRAL] OK, uh, no, she she's gonna.
[CUSTOMER][NEUTRAL] Oh, OK, alright, I'm gonna uh transfer you to her just a second, OK.
[AGENT][NEUTRAL] I can barely hear you guys.
[CUSTOMER][NEUTRAL] OK, yeah, I don't know what's wrong with our phone today.
[CUSTOMER][NEGATIVE] We're having issues. I can you hear me now better?
[AGENT][POSITIVE] Yes, I can, thank you.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] So let's get the address changed. That's strange. They have a wrong uh like a typo in the address that I gotta get changed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Would you like for me to transfer you to customer service or you guys done with the claim the benefits and claims department and you want me to transfer you?
[CUSTOMER][POSITIVE] Oh I yeah I just need to be transferred so that they can change the uh the address for me like you said because it's wrong. I think we're finished with her, right? Yeah, we are, ma'am thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So customer service is gonna wanna speak to the um insured for her address to be updated.
[CUSTOMER][NEUTRAL] That's me.
[AGENT][NEUTRAL] Oh, OK, I apologize. I thought you was. Hold one moment, OK.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] I'm great, thanks for asking, [PII]. This is [PII]. I have a pro uh insured on the phone. She's calling about her um bill, her mailing address when she when she went to verify her benefits. There's a typo in her address and she needed to be updated.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright, what's the policy number?
[AGENT][NEUTRAL] It is 214-1849. It's 214-1849 for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what is your callback number?
[AGENT][NEUTRAL] Her callback number is [PII] and it should be 34th [PII] instead of 38th [PII], but I'm gonna transfer so she can verify that for you.
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][NEUTRAL] Hold one moment. You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look everything I
[AGENT][POSITIVE] Hello Ms. [PII], I'm gonna transfer you to lender in customer service. She's gonna update your mailing address for you, but thanks for calling APL, and you have a great day.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Oh perfect.
[CUSTOMER][POSITIVE] Thank you honey you too.
[AGENT][POSITIVE] Have a great day, [PII].
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thanks bye.