AccountId: 011433970860
ContactId: df99d127-b3ea-4bf6-a58d-673b2ac85282
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449880 ms
Total Talk Time (AGENT): 195123 ms
Total Talk Time (CUSTOMER): 144065 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/df99d127-b3ea-4bf6-a58d-673b2ac85282_20250513T13:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office to check on the patient's benefits.
[AGENT][POSITIVE] OK, yes, ma'am. I can verify benefits for you. Give me one quick moment, please. I apologize.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That's the [PII]. OK. And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 02593385
[AGENT][POSITIVE] Thank you so much, give me one quick moment please.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Her name is [PII], [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy, and I apologize, Ms. [PII], you said you also wanted benefits?
[CUSTOMER][NEUTRAL] Oh here it is.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Uh, what benefits are you needing? Go on.
[CUSTOMER][NEUTRAL] I mean, does she have a um for an inpatient surgery inpatient delivery.
[AGENT][NEUTRAL] OK, so this is for.
[CUSTOMER][NEUTRAL] She was made responsible in my on my office. They applied the deductible of 3,859 and I need to know if she has funds on the American Public life insurance policy.
[AGENT][NEUTRAL] OK, I can verify that for you. Give me one moment. Um, not a guarantee of payment, just a verification of coverage. Uh, she has an inpatient benefit that pays up to $4000 per calendar year of primary deductible co-pay or co-insurance that is applied, but I don't show she's used any of the benefits, so it is available on the policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] It is available? OK, awesome, uh.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Perfect, can I have your address, the address information for claims?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you have an electronic uh payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yes, anything that I need to send with the claim, this plan, the EOB from primary.
[AGENT][NEUTRAL] Yes, ma'am. Uh, we are secondary to that EOB is needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I also have another patient that I wanted to check if you give me a second.
[AGENT][NEUTRAL] OK, give me one moment please while I type in this note.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I um.
[AGENT][NEUTRAL] OK. And what's the next policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] It is 026-054.
[CUSTOMER][NEUTRAL] 70.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Louis, 7.
[AGENT][NEUTRAL] Thank you and patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. Thank you. Uh, let's see. I'm showing her effective date is [PII] and she is active. And you're needing inpatient benefits for her as well?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see, not a guarantee of payment again, uh, just verification coverage. She has an inpatient benefit max up to $3000 per calendar year.
[AGENT][NEUTRAL] And give me a moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, so far I show she's used some. Give me one moment. I'll let you know how much she has remaining so far.
[AGENT][NEUTRAL] And it shows she has 422, 27 remaining for this year for inpatient.
[CUSTOMER][NEUTRAL] 422.
[AGENT][NEUTRAL] 27 remaining. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, we signed a claim and you guys said that it was charged occurred after coverage termination day.
[AGENT][NEUTRAL] Oh, do you have a claim number or the date of service?
[CUSTOMER][POSITIVE] I have let me see effective day.
[CUSTOMER][NEUTRAL] Claim number PLG.
[CUSTOMER][NEUTRAL] 221,270
[AGENT][NEUTRAL] Uh, it's not one of our claim numbers.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Maybe from her primary, but um it's not, she hadn't used any of her benefits.
[CUSTOMER][NEUTRAL] OK, for their service, their service [PII].
[AGENT][NEUTRAL] OK, and this is for a physicians charger facility?
[CUSTOMER][NEUTRAL] Yes, physician charges, Doctor uh Doctor [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Florida, uh, Women Care.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and this is looks like for delivery?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, I show on this claim, we paid $1,616.31.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, hold on.
[AGENT][NEUTRAL] Uh, it looks like it's being processed today, so that, uh, go, that check will go out tomorrow.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, OK, makes sense now.
[CUSTOMER][NEUTRAL] Do you have the check information?
[AGENT][NEUTRAL] Uh, no, ma'am, because it was just processed today, it won't, uh, show until tomorrow when the check goes out and it's mailed with the EOB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you. Do I have a reference number for this call?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Your name is?
[AGENT][NEUTRAL] [PII], last initial [PII]. And is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] That's gonna be all, thank you very much.
[AGENT][POSITIVE] You are welcome. Thanks for calling APL and you have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.