AccountId: 011433970860
ContactId: b6637a6e-373b-47e2-9144-a4ab7e441932
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498940 ms
Total Talk Time (AGENT): 156001 ms
Total Talk Time (CUSTOMER): 160529 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/b6637a6e-373b-47e2-9144-a4ab7e441932_20250305T18:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling from the doctor's office. I wanna check the benefits and eligibility for one member.
[AGENT][POSITIVE] OK. I can help you with the benefits and the eligibility.
[AGENT][NEUTRAL] Can I call and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, consultants and neurological surgery.
[AGENT][NEUTRAL] OK, your name and your callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII], [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It's for um
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII], and the policy number 1317924.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][POSITIVE] OK. I do show that [PII] does have an active policy with us and her effective date.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary.
[AGENT][NEUTRAL] The gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has an inpatient benefit amount per occurrence of $5000.
[AGENT][NEUTRAL] And let me see if she has anything for outpatient.
[CUSTOMER][NEUTRAL] You said the name of the the insurance is American Pioneer Life?
[AGENT][NEUTRAL] No, APL.
[CUSTOMER][NEUTRAL] APL and it's, what is it for? American?
[AGENT][NEUTRAL] Public life.
[CUSTOMER][NEUTRAL] Public.
[CUSTOMER][NEUTRAL] Life? OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and then she also has an outpatient benefit.
[CUSTOMER][NEUTRAL] So I'm looking for
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] She also has an outpatient benefit amount per occurrence of $500.
[CUSTOMER][NEUTRAL] OK, so let me understand. We did surgery on her outpatient and we billed the primary and United Healthcare is the primary and all went towards her deductible responsibility that she has to pay $1,709. Now, if I send that bill to you, you, would you cover or she has to copay or I'm sorry, I'm trying to understand if this balance for outpatient will deductible will be covered.
[AGENT][NEUTRAL] OK. Let me look and see if she has surgery benefits for a surgical facility on her policy. Let me check real quick. It was done outpatient and not inpatient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, outpatient.
[AGENT][NEUTRAL] OK, let me check real quick.
[CUSTOMER][NEUTRAL] OK. Oh, and yeah, in a facility.
[AGENT][NEUTRAL] Was it an ambulatory facility?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Or was it a doctor's office?
[CUSTOMER][NEUTRAL] No, freestanding facility, hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me look. I've got it pulled up. It's gonna be just a moment so I can read it real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I haven't forgot you. I'm looking.
[CUSTOMER][POSITIVE] OK. I understand. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it is um covered for an outpatient, freestanding outpatient surgery center for accident or sickness.
[AGENT][NEUTRAL] There's no deductible.
[AGENT][NEUTRAL] And it covers up to $500.
[CUSTOMER][NEUTRAL] Uh, so you only will pay $500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the rest is a responsibility. OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So let me document this. Give me one quick sec here.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You said medical, right? This is not accident, it's medical. So,
[AGENT][NEUTRAL] Right, this, right, it's a medical policy that's a supplement to the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to send you paper and I will send you a copy of the EOB and uh to, what is your PO box?
[AGENT][NEUTRAL] The PO box for claims is [PII].
[AGENT][NEUTRAL] And it's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, so for claims I send it to [PII].
[CUSTOMER][NEUTRAL] And it's in [PII] city and the state is OK, right? The code?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And the zip code is [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. So it was a different address for what she had on the insurance card. Maybe it's an old one.
[AGENT][NEUTRAL] It could be, she's had this policy for a while.
[CUSTOMER][POSITIVE] Yeah, OK, perfect. So it covers up to $500 and after that, that might be her responsibility for the balance. I appreciate that you helped me. Um, thank you so much and your name is?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK, perfect. Do you have a reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] Perfect. I appreciate it, [PII]. Thank you so much, my dear. Have a great day.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a blessed day and thanks for calling APL ma'am.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.