AccountId: 011433970860
ContactId: bda42508-9206-4757-b29f-7d5343e428d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388920 ms
Total Talk Time (AGENT): 212762 ms
Total Talk Time (CUSTOMER): 95336 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/bda42508-9206-4757-b29f-7d5343e428d8_20250217T20:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I am calling from Valley Medical Center. I am trying to find out if this patient's insurance is a limited benefit plan or if it's a gap plan.
[AGENT][NEUTRAL] OK, [PII], so you're trying to find out what type of plan the member has with us, limited benefit or supplemental medical?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] D 468-02018.
[AGENT][NEUTRAL] OK, now that Kathy is not a policy number for American Public Life. That's a 90 degree benefit number.
[AGENT][NEUTRAL] Is there another
[CUSTOMER][NEUTRAL] It's a what number?
[AGENT][NEUTRAL] A 90 degree benefits policy number?
[CUSTOMER][NEUTRAL] That's, that's all I have. I don't have a copy of a card.
[AGENT][NEUTRAL] OK, I can see some of these members have dual plans, one with APL and also 90 degree benefits. I can try, do you have, um, do you have the primary insured's social?
[AGENT][NEUTRAL] If not, I can try. OK, you do. OK. All right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I have it. I have, I have his so it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So I'll check our system before I transfer you. I hate to transfer you to 90 degree benefits and then they end up having to transfer you back.
[AGENT][NEUTRAL] So let me see if first he has a policy with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say 537459-507. Is that correct?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. So I have located a policy under that social, just one moment.
[AGENT][NEUTRAL] OK, and so [PII], any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], birthday [PII].
[AGENT][NEUTRAL] Thank you. So, I did find a limited benefit plan that he does have with APL.
[AGENT][NEUTRAL] Again, it's a hospital indemnity limited benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 02520645.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Being a limited benefit plan, does it cover any outpatient hospital procedures?
[AGENT][NEUTRAL] I can check to see if this plan has benefits on that. Just one moment.
[AGENT][NEUTRAL] OK. What, uh, so again, because of it being a limited benefit plan, he has a surgery benefit for outpatients.
[AGENT][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] Yeah, this is an outpatient this is uh I don't, it's, he's coming in for an EGD which is an outpatient, I guess you could classify it as a surgery, um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We would just have to receive the claim in order to review that to determine if benefits are payable, um.
[AGENT][NEUTRAL] On his, yeah, but that's not a diagnostic test.
[CUSTOMER][NEUTRAL] So they would have to submit an op to determine it?
[AGENT][NEUTRAL] That is correct. Because this uh uh when I said that, we would just need to receive the claim for review because on this policy, it's, his benefits consist of hospital admission, then the outpatient surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, benefit, which is
[CUSTOMER][NEUTRAL] Yeah, there will be, there wouldn't be an admission there would be no admission, it would just be the.
[CUSTOMER][NEUTRAL] Procedure.
[AGENT][NEUTRAL] So he, so the surgery, surgery in a hospital?
[AGENT][NEUTRAL] Or hospital outpatient facility or free-standing outpatient surgery center, that benefit is $250 per day and a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] $250 a day allowed.
[AGENT][NEUTRAL] For one day per calendar year.
[CUSTOMER][NEUTRAL] And would it need and would it need prior off then?
[AGENT][NEUTRAL] No, this does not, there's no prior authorization required on this limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that's what I needed to know. I, oh, is there a reference number for this call?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date and do you have the correct mailing address for claims?
[CUSTOMER][NEUTRAL] Um, what we have listed is.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Since she didn't have the policy number, I was just, OK.
[CUSTOMER][NEUTRAL] I have a [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, that is correct. Uh-huh. And then once the claim has been processed, [PII], we have a portal that you should be able to check claim status and also have access to our EOB Cathy, and our portal website is secured.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK great I appreciate you looking all that up for me. I hope you have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I hope you do too, [PII], and if that's all then that I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][POSITIVE] You're welcome