AccountId: 011433970860
ContactId: c6d9d2b8-5489-431f-8dce-3488884cd216
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611099 ms
Total Talk Time (AGENT): 106212 ms
Total Talk Time (CUSTOMER): 294771 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/c6d9d2b8-5489-431f-8dce-3488884cd216_20250428T19:22_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi [PII], my first name is [PII]. I'm calling from a provider's office actually, hang on, you picked it up so quick, which I'm not complaining about. I wasn't even ready, but that's all good. [PII], um, 428.
[CUSTOMER][NEUTRAL] OK, so, um, again my first name is [PII] calling from an ambulatory surgical center and a patient was in our center on [PII], had surgery, um, and they gave you as a secondary insurance. I just wanted to see exactly. I've never heard of you before. I wanted to call to see, you know, who, what, we are kind of thing.
[AGENT][NEUTRAL] OK. Do you have the policy number, [PII]?
[CUSTOMER][NEUTRAL] This is let me just uh check first it's American Public Life, is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so insured's name coverage group number effective date.
[CUSTOMER][NEUTRAL] Um, in hospital benefits.
[AGENT][NEUTRAL] Should be like a
[AGENT][NEUTRAL] Yeah, certificate number.
[CUSTOMER][NEUTRAL] There's a um two certificate numbers. They one starts in hospital, the other one starts outpatient hospital, then benefit certificate number. We're we're outpatient. Do you want me to give you that one?
[AGENT][POSITIVE] Yes, that'd be perfect.
[CUSTOMER][NEUTRAL] 01719419 [PII] 8.
[AGENT][NEUTRAL] OK. Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] date of birth [PII].
[AGENT][NEUTRAL] OK, and you're wanting to check on eligibility and benefits, is that right?
[CUSTOMER][NEUTRAL] Well, I guess everything I've never heard of you all um you are a commercial insurance is that correct?
[AGENT][NEUTRAL] Yes, and this is like a gap plan. It's for, it's a secondary policy.
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] OK, so a gap plan secondary policy just make sure we're on the same page. To me, a secondary policy is a policy purposely is a supplement is a supplement policy specifically to cover or to be there after a primary. It's not a primary insurance.
[AGENT][POSITIVE] Yes, correct, yeah, um.
[CUSTOMER][NEUTRAL] OK, so was he covered on, was he active on [PII] of this year?
[AGENT][NEUTRAL] Yes, the policy is effective [PII].
[CUSTOMER][NEUTRAL] And it's still currently active?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, so his primary, I think was Cigna. Hold on a sec, yeah, was Cigna. So, um, what is it that you all cover? It like I said, it was, um, day surgery on an outpatient basis at an ambulatory surgical center.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, it looks like under this policy, which is not a guarantee of payment, it's a basic outline of the policy. His benefit is $6600 per calendar year maximum benefit payable, um, and that would pick up deductible, co-pay, co-insurance after primary processes up to 6600.
[CUSTOMER][NEUTRAL] So he, it's um so the maximum that'll pay out per year maximum benefit is 6600 and it'll cover a pick up deductible.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Co-insurance copay, is that what you said?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, hang on a second.
[CUSTOMER][NEUTRAL] OK, so there was a balance of $3910.71. Um, we didn't send it into you. Could you tell me if there's anything that's been used?
[AGENT][NEUTRAL] Um, it looks like so far for [PII], the patient has used 547-87.
[CUSTOMER][NEUTRAL] $547.87.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so $547.87. Let me see if I can look at something real quick to get a better idea. Hold on.
[CUSTOMER][POSITIVE] I'm going as quick as I can.
[AGENT][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] You know, haste makes waste. The quicker I try to go, the slower I am 8008.
[CUSTOMER][NEUTRAL] 43, give me just a minute I'm still here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 43
[CUSTOMER][NEUTRAL] For 12.
[CUSTOMER][NEUTRAL] 410.
[CUSTOMER][NEUTRAL] 19.
[CUSTOMER][NEUTRAL] 43.
[CUSTOMER][NEUTRAL] What's this
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] CO 11 CO 11 member member deductible.
[CUSTOMER][NEUTRAL] OK, so it looks like um.
[CUSTOMER][NEGATIVE] What they're not paying.
[CUSTOMER][NEUTRAL] OK, so it looks like the whole $39,003,910 was applied to the, the, um, deductible, so, um.
[CUSTOMER][NEUTRAL] OK, so that takes care of that, so I'm almost done.
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] The added address to mail claims into.
[AGENT][NEUTRAL] Um, our address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so it would be it would be made out to [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And I didn't get the zip code.
[AGENT][NEUTRAL] Uh zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] OK and just send the claim off to that address is it possible to fax it in?
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[AGENT][NEUTRAL] 3659423.
[AGENT][NEUTRAL] And then we also have a payer ID.
[CUSTOMER][NEUTRAL] Well, the thing is we need to send it with the primary EOB. You would need that, right?
[AGENT][POSITIVE] Yes, we do, yeah.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and if we fax it in, is that the claims department?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and this sounds it might sound like a strange, strange question, but do I need to put a cover sheet with the EU can I send the EOB, um, not the EUB. Can I send a claim form with the EUB attached without a cover sheet or does need a cover sheet?
[AGENT][NEUTRAL] Uh, you don't need a cover sheet.
[CUSTOMER][NEUTRAL] OK, and what's the ETA on them for on new processing claims?
[AGENT][NEUTRAL] Our processing schedule is about 7 to 10 working days.
[CUSTOMER][NEUTRAL] From the time of receipt.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and [PII], can I have a call reference number please?
[AGENT][NEUTRAL] And it's just my name, [PII], first initial to last name, [PII], and then today's date. And anything else I can help with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and it's
[CUSTOMER][NEUTRAL] Nope, it's [PII]
[AGENT][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] Oh, [PII] Yes, how do you spell [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh OK [PII]
[CUSTOMER][NEUTRAL] I was gonna Google it, but you asked if there's anything else you could do, so I figure that's send me a minute or two. OK, OK, thank you, bye bye.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day. Bye bye.