AccountId: 011433970860
ContactId: d24e03a1-a2e1-463f-94e8-d57046ed4c08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450410 ms
Total Talk Time (AGENT): 164682 ms
Total Talk Time (CUSTOMER): 215719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/d24e03a1-a2e1-463f-94e8-d57046ed4c08_20250324T16:08_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] Hi [PII], um, yes, uh, do you need the group number or my name or?
[AGENT][NEUTRAL] I'm needing your name and then a callback number.
[CUSTOMER][NEUTRAL] OK, uh, [PII].
[AGENT][NEUTRAL] Are you the provider or the insured?
[CUSTOMER][NEUTRAL] I'm the insured.
[AGENT][NEUTRAL] OK, and may I have your call back number please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, yeah, that's the group number.
[AGENT][NEUTRAL] It would be the benefit certification number.
[CUSTOMER][NEUTRAL] Mm, I have the card in front of me it says group number plan.
[AGENT][NEUTRAL] Do you see outpatient benefit certification number?
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] May I have that please?
[CUSTOMER][NEUTRAL] OK, 021.
[CUSTOMER][NEUTRAL] 68478
[CUSTOMER][NEUTRAL] M like Mary. L like Lillian 8.
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth with me?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And do you have an email address that you would like for me to enter on file?
[CUSTOMER][POSITIVE] Oh yeah, that would be good. It's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I will get that entered in the system and could you verify if the mailing address is correct in our system?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII]. That's my home, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how may I assist you?
[CUSTOMER][NEUTRAL] I don't know. OK, I have a, um, a doctor prescribed for me two different procedures. One is the, uh, an MRI of my hip and the other one is a bone scan, bone scan of my hip also. So I would like to know if this APL is gonna cover, you know, the additional, the, and then for this year if I already use some of the.
[CUSTOMER][NEUTRAL] Coverage, I don't know how do you call that. I'm sorry I'm not very.
[CUSTOMER][NEUTRAL] Knowledgeable of insurance.
[AGENT][NEUTRAL] OK, so do you know if this is gonna be done within an outpatient facility or in the office?
[CUSTOMER][NEUTRAL] Mm it's gonna be in the at the Baptist hospital. I don't know what is considered that it's outpatient, no, I imagine it is, it's, it's not through the hospital they have an office there.
[CUSTOMER][NEUTRAL] That's considered outpatient? I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not to do, you know, going through emergency or being in the, in the hospital, hospitalized and all that. It's, it's in one of the offices. I have to make the appointment. It's in one of the offices that they have for this imaging and uh the the bone scan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that considered outpatient?
[AGENT][POSITIVE] It's it we would for that we would have to see how they submitted in, but I do, I'm pulling those benefits up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it depends how they bill you.
[AGENT][NEUTRAL] Yes, it's according to how we when we receive the bill if they submit it in as for office or if they're submitting it in for outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] When it says in hospital benefit is what you're hospitalized and then they take you from your room to do this scanning that's in hospital.
[AGENT][NEUTRAL] It's in hospitals when you stay.
[AGENT][NEUTRAL] In the hospital, if you're confined within the hospital.
[CUSTOMER][NEUTRAL] Correct. I'm not, I'm not, I'm not gonna be in the hospital. It's, it's so it's gonna be outpatient, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry for my questions, but you know the jargon here for the insurance is very delicate, you know, one little letter and then you get charged $5000 you know, so.
[AGENT][NEUTRAL] Yes, yes, I understand. And also you wanted to know if you had used any of your benefits for 2025. So for your benefits.
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, for your benefits verification of coverage does not guarantee the payment of the claim. If it's done within an office setting or outpatient facility, you do have up to 20, I mean I'm sorry, up to $2000 per calendar year.
[AGENT][NEUTRAL] And that will go towards your primary insurance deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The amount that you've used for this year is showing $80.
[CUSTOMER][POSITIVE] That's it? OK, so that's good.
[CUSTOMER][NEUTRAL] And then uh so that's for our patient, OK.
[CUSTOMER][NEUTRAL] So and do you know if this um if these procedures are gonna be covered with the APL for the gap, the insurance gap?
[AGENT][NEUTRAL] As long as the procedure is for sickness and injury and it's not for preventative and wellness.
[CUSTOMER][NEUTRAL] I have the CPT4 codes. Can you verify that with me if I give you the codes?
[AGENT][NEUTRAL] We don't process claims over the phone. We can only just give you the benefits and advice of those benefits.
[CUSTOMER][NEUTRAL] OK, so you said that this is gonna be covered if it's uh if it's preventive no or I'm sorry, I hear you, can you repeat that again?
[AGENT][NEUTRAL] We cover sickness or injury. Now, if it's for preventative or wellness, we don't cover that.
[CUSTOMER][NEUTRAL] No, yes, I have injury because I, I'm in pain, OK, so I wouldn't considered injury, no?
[AGENT][NEUTRAL] If, if it's for sickness or injury, then it is the 2000 per calendar year benefit max.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and then I I need to give them the this information to the when I schedule the procedures, no, that I have a gap insurance.
[AGENT][NEUTRAL] Now if you want to, you can go ahead and contact them and when you do the scheduling over the phone, you could just give them that information and they should contact us. Now if they don't submit the bill or accept your secondary insurance, you do have the option to submit the documentations in once your primary insurance processes it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and um and.
[CUSTOMER][NEUTRAL] Submit the I have it in the back where to submit the claims American Public Life in [PII], no, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then can I submit this by email if I have to?
[AGENT][NEUTRAL] We only accept it via the secured portal, fax or mail.
[CUSTOMER][POSITIVE] I see. OK, OK, perfect. Hey, listen, thank you very much for your uh help on this.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, hopefully not, thank you.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Take care, bye.
[AGENT][NEUTRAL] Bye bye.