AccountId: 011433970860
ContactId: d8f2d4c6-14f2-47ee-8dcc-d5a41c006bb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386779 ms
Total Talk Time (AGENT): 188255 ms
Total Talk Time (CUSTOMER): 156684 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/d8f2d4c6-14f2-47ee-8dcc-d5a41c006bb3_20250203T17:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from Atrium Health Madison Rehabilitation Hospital. We have gotten an insurance card for a person that was admitted to us initially we did not think they had insurance, um, but we've now gotten a card, and I'll need to see what we need to do to, um, submit a retrospective, um, authorization for admission.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you have a patient that was admitted inpatient that you're needing to find out if prior authorization was required, is that correct? Yes, ma'am. I can help you with that. And so first off, [PII], what is a good callback number for you?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the members of the thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] And my last initial is D for Denman.
[CUSTOMER][NEUTRAL] Um, I have policy number 02592902.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] What does APL stand for?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, and [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] Mhm.
[CUSTOMER][NEUTRAL] The last name is [PII] The first name I'll have to spell it for you. I think it's pronounced [PII] His birthday is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So he does show as being the spouse of the subscriber on this plan. Now this is not a major medical coverage. This is a hospital indemnity limited benefit plan. So therefore there is no prior authorization with us not or required with us on this type of policy.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No prior authorization on policy, OK.
[AGENT][NEUTRAL] We
[AGENT][POSITIVE] Correct. And the policy does show as active.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][NEUTRAL] So it went into effect [PII].
[AGENT][NEUTRAL] Yes, ma'am, that is correct. And do, and do you have the correct, 00, OK. And do you have the correct mailing address for claims?
[CUSTOMER][NEUTRAL] OK, alright, he was admitted to us on [PII].
[CUSTOMER][NEUTRAL] Um, on the card it says attention IMA incorporated [PII] EDI Payers 64556.
[AGENT][NEUTRAL] Uh-huh. OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That is correct, mhm.
[AGENT][POSITIVE] Yes, ma'am. That is correct. And then
[CUSTOMER][NEUTRAL] OK, and what are you said it was a limited indemnification?
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is correct. It is a limited benefit plan.
[CUSTOMER][NEUTRAL] What are the benefits for rehab inpatient rehab?
[AGENT][NEUTRAL] Let me look to see if he has inpatient rehab benefits. Let me just, uh, and I may not be able to even see that yet because this policy was literally just issued.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] And it's physical rehab for a stroke, not.
[AGENT][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] OK, not substance abuse.
[AGENT][NEUTRAL] Right, OK, yeah.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] What I can see on his policy shows a rehabilitation benefit of 30 days per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per cover person.
[AGENT][NEUTRAL] With a $50 benefit amount per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $50 benefit?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You are certainly very welcome. So is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] That's it. So maybe I need to ask this question. Is this, and forgive me for is this comparable to like what I see advertised for Aflac when you say it's a hospital indemnification plan it's not really.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's not really in is it true like health insurance?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Well, it's, it's a limited benefit plan. We are not a major medical carrier, so it pays, only pays specific amounts for certain coverage services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does a specific payment go to the patient or does it go to the facility?
[AGENT][NEUTRAL] Whomever files the claim.
[CUSTOMER][POSITIVE] Whoever files the claim, OK, thank you so much.
[AGENT][NEUTRAL] Mhm. You are certainly very welcome. And is there anything, oh, and then one last thing, Say, I forgot to tell you is once the claim has been processed by APL, then um we do have a portal which you should be able to check claim status in and our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That was secured [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Let's see. I'm gonna repeat it one more time. I think I missed a dot. So it's secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] OK, well, you are certainly very welcome and again thank you for calling [PII]. I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.