AccountId: 011433970860
ContactId: c7bb31a4-15a7-4611-983b-91527865b643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394059 ms
Total Talk Time (AGENT): 114434 ms
Total Talk Time (CUSTOMER): 159203 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/c7bb31a4-15a7-4611-983b-91527865b643_20250506T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, uh, [PII], I need to verify, um, our network status please.
[AGENT][NEUTRAL] OK, may I have your name and then a callback number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. callback number is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is gonna be 02519567.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, one second here.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Not a major
[CUSTOMER][NEUTRAL] What is his date of birth?
[CUSTOMER][NEUTRAL] OK 1 2nd.
[CUSTOMER][NEUTRAL] over
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Probably going to have to call you back to get this information because.
[CUSTOMER][NEUTRAL] I don't have his date of birth. Is there anything else that you can, um, verify other than his date of birth? You like the home address or anything?
[AGENT][NEUTRAL] Well, we have to pull, we have to go by the member's name and their date of birth to verify the member's policy.
[AGENT][NEUTRAL] But you was trying to see if we were in network or what was your network for us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, his date of birth is [PII], sorry.
[AGENT][NEUTRAL] Thank you and thank you so much [PII] for verifying the policy, but you were trying to see verify the network benefit or?
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, if we're in network with this policy.
[AGENT][NEUTRAL] OK, so the way that this policy works is based off of the major medical insurance, we're considered their supplemental or gap, so it's not like a major medical, it's not based off of in or out of network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Supplemental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then do you guys show that Cigna is the primary insurance for, for Caleb?
[AGENT][NEUTRAL] I wouldn't have their primary information we would just receive it once they go to the provider and then the provider will submit that over to us and that's how we would know they're secondary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then you, OK, and then what is y'all's reimbursement?
[AGENT][NEUTRAL] I mean their primary.
[AGENT][NEUTRAL] On what benefit, what would you like for me to verify?
[CUSTOMER][NEUTRAL] Um, let's just say a specialty office visit.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[AGENT][NEUTRAL] And for this member, verification of coverage does not guarantee the payment of the claim. For the office visit fee, the member does not have that benefit, but for a procedure that is rendered within the office setting, the member has up to $2,025 per calendar year that will cover the primary's deductible, co-insurance, or co-pay for the procedure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy is only for sickness and injury. It does not cover any type of preventative or wellness.
[CUSTOMER][NEUTRAL] OK, so you said for in-office procedures up to $2,225 per day and it covers the deductible and the co-insurance, correct?
[AGENT][NEUTRAL] It's up to 2025 and it covers deductible co-insurance or co-pay for the procedures, just not for their office fee.
[CUSTOMER][NEUTRAL] They just
[CUSTOMER][NEUTRAL] OK, OK, and then for ambulatory surgery center or outpatient, um.
[CUSTOMER][NEUTRAL] Surgery, what are your, what is the benefit cover for the plan cover then?
[AGENT][NEUTRAL] For the outpatient, that members still have up to that $2,025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much has the member used um year to date with you guys?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] As of right now, the member has used the total amount of $422.82.
[CUSTOMER][NEUTRAL] 4 22 84.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so this is not a major medical, this is like a.
[CUSTOMER][NEUTRAL] Supplemental gap insurance that does not cover any preventative care, um, covers specialty office visit benefits but only if it's a procedure that's being performed in the office.
[CUSTOMER][NEUTRAL] Uh, and then that's up to the [PII] per calendar year and then the same applies for their ambulatory surgery or outpatient hospital benefits.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And has no network.
[CUSTOMER][NEUTRAL] Network is based upon the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I think I have everything I need thank you.
[AGENT][POSITIVE] You're welcome and thank you so much for calling American Public Life. [PII], have a great day.
[CUSTOMER][NEUTRAL] You you as well. Bye.
[AGENT][POSITIVE] Thank you, bye.