AccountId: 011433970860
ContactId: ce1aff48-1e38-45c3-b8f6-cd282d5a155b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413429 ms
Total Talk Time (AGENT): 237781 ms
Total Talk Time (CUSTOMER): 128629 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/ce1aff48-1e38-45c3-b8f6-cd282d5a155b_20250207T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was just transferred over from 90 Degree Benefits, and I was calling to see on the medical side if um a patient has out of network benefits on their plan, and they said they couldn't help me with that that would have to go through you guys.
[AGENT][POSITIVE] OK, I can definitely get that plan pulled up. We'll see what kind that is, um, and I'll be able to let you know. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Um, do you have their policy number with us? If it's a policy number that begins with a D that's just going to be through 90 degrees.
[CUSTOMER][NEUTRAL] Yeah, she said you won't be able to look it up with the deed one she said could possibly the name and date of birth?
[AGENT][NEUTRAL] Right, do you have their social?
[CUSTOMER][NEUTRAL] Uh, I don't think I have the last four digits. I get the social. Let me look.
[AGENT][NEUTRAL] OK, I would need the full social, um, yeah, we could try, uh, just if you wouldn't mind spelling out their first and last name for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Absolutely. It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last name [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK thank you one moment.
[AGENT][NEUTRAL] Uh, what state, uh, does [PII] live in?
[CUSTOMER][NEUTRAL] [PII]. I gave you the city.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] And then, uh, did you have his date of birth?
[CUSTOMER][NEUTRAL] I do. It is [PII].
[AGENT][POSITIVE] Perfect. OK, I do believe I found it.
[AGENT][NEUTRAL] And this was for medical, OK, yes, um, so of course it is active, uh, the effective date was [PII]. Alrighty, so this plan is a bit different, um, it is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it does not have any sort of network, um, no copays, no deductibles, no pre-ops required, um, it just pays a set dollar amount per covered procedure or office visit, um, there is no network.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, now they told us we were not in network though so then we still can see him and we would be paid, is that what you're saying?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, um, what, what's, um, as this is a limited, um, what are you going to be seeing him for so I would make sure that that would be covered at all under this policy.
[CUSTOMER][NEUTRAL] Do you just want like the code for an office visit it is with that?
[AGENT][NEUTRAL] Is that is it just an office visit?
[CUSTOMER][NEUTRAL] It's so we're pain management.
[CUSTOMER][NEUTRAL] Well today it's an office visit if he would have an injection, you know, then there would, we would go there but again his primary is actually workers' comp. We just do this as backup to protect, you know, the doctor and the patient from any outstanding balances.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see, of course.
[AGENT][NEUTRAL] Of course. OK, so, um, alright, I, then of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so for this policy, uh, a physician's office visit, um, regardless of what is being done, treatment received, uh, it would pay a benefit of $50 per visit for this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it doesn't, it wouldn't matter what code or what our NPI number, anything like that. It would just, he, he would only get $50 toward any specialist or any type of other doctor and he would, he would be responsible for the balance.
[AGENT][NEUTRAL] Right, and now he does.
[AGENT][NEUTRAL] Right, so it's the $50 flat, um, for a physician's office visit and now he does have some other benefits for, um, like diagnostic testing typically and I can make sure, um, I'll get the policy pulled up just to make sure, but most of the time with these kinds of policies that diagnostic testing benefit is going to be limited to things like uh MRIs, CT scans, um, things like that. But let me double check. Give me just a moment. I'm gonna get that pulled up just for good measure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah it looks like the extent of the rest of his benefits are going to be for like hospital admission or ambulatory um.
[AGENT][NEUTRAL] Things like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, bear with me just a moment it is thinking about it.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] That's where my computer knows when it's Friday.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this diagnostic test, um benefits does cover medical imaging tests. So like I said, the MRI, CT scans, things like that. Um, also advanced study or follow-up tests. So, uh, nuclear stress test, sleep studies, um, a lot that I'm not sure I'm gonna be able to pronounce. Um, but it doesn't sound like that's what he's going to be seen for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That's OK, that's OK, yeah, that's not the things we're doing right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And he does have a prescription drug benefit as well. I'm not sure if that would be helpful information, but again that does seem like, OK, yes, um, so that does seem to be the extent of his coverage.
[CUSTOMER][NEUTRAL] Yeah, it's on his card, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, in regards to what he's gonna be seeing with y'all.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] So then again our bills wouldn't be denied they would just be paid at the limited rates of whatever's on the policy, OK.
[AGENT][NEUTRAL] That's correct, yes, and you just send that, um, you can send that to us, um, do you have our, uh, claims information?
[CUSTOMER][NEUTRAL] They gave us the mailing address for bills is coming through the 90 degree benefit. Does it not do that?
[AGENT][POSITIVE] You can um if there's a hiccup or anything you could just give us a call and we could see what we can do to help.
[AGENT][NEUTRAL] Sometimes these multi plans, these multi plans can be kind of confusing um so if they gave you their information um you could go ahead and do that with them, but if there's a a hiccup or anything like that just give us a call we'll see what we can do.
[CUSTOMER][NEUTRAL] Or I mean where where should we.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I didn't get a direct number for you they transferred me.
[AGENT][NEUTRAL] Oh sure, yeah, let me know when you're ready.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what company was this for?
[AGENT][NEUTRAL] This is American Public Life or APL.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] American
[CUSTOMER][NEUTRAL] Public life.
[CUSTOMER][NEUTRAL] OK, but you said we should not bill you directly, is that correct?
[AGENT][NEUTRAL] If they gave you their information, I would go ahead and just go with them.
[CUSTOMER][POSITIVE] OK, and then, OK, sounds good.
[AGENT][NEUTRAL] Alright, did you have any other questions for me, [PII]?
[CUSTOMER][NEGATIVE] No, I do not thank you.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.